Pharmacodynamic monitoring during acute intervention in ischaemic heart disease using a new echo‐Doppler device.

Abstract

Infirmary at Leeds, Leeds 1 We have utilised a new non-imaging echo-Doppler cardiac output device, using the principle of attenuated compensated volume flow (ACVF), to assess the cardiovascular effects of atenolol and buccal nitroglycerine (NTG) in a placebo-controlled study of 30 patients with coronary disease. 2 Atenolol (4 mg i.v.) reduced heart rate, cardiac output and time-averaged mean aortic velocity (P < 0.01) and increased systemic vascular resistance (P < 0.01). 3 Buccal NTG (5 mg) reduced systemic mean arterial pressure (P < 0.01), cardiac stroke volume (P < 0.05) and stroke length (P < 0.01). 4 Thus although both drugs reduced time-averaged aortic velocity (an index of cardiac performance), the concomitant reduction in cardiac stroke length and tachycardia suggested sub-optimal cardiac filling for buccal NTG, whereas for atenolol (with the associated increased systemic vascular resistance but unchanged stroke length) attenuation of sympathetic stimulation at cardiac P-adrenoceptors.S The ACVF method of cardiovascular monitoring should prove useful in human pharmacodynamic studies.

Comparison and reproducibility of transthoracic bioimpedance and dual beam Doppler ultrasound measurement of cardiac function in healthy volunteers.

“…of the difference was 0.3 1 min-1). The ACVF Doppler has also been found to be useful in studying haemodynamic responses to drugs in patients with angina pectoris at rest (Silke et al, 1990). In general, the limitations and possible role of the ACVF Doppler in patient management have not yet been defined.…”

“…The Doppler indices derived from each are combined to avoid the need for imaging of the aorta and measurement of aortic root diameter, while measuring CO (Evans et al, 1986). Although advocated for patient management, neither has been widely accepted in clinical use because of variable correlation with what is taken to be the 'gold standard' of CO measurement in clinical medicine, the thermodilution technique (Kalkat et al, 1988;Mattar et al, 1986;Silke et al, 1990;Wong et al, 1988). Both methods seem satisfactory in studies with normal subjects (Jewkes et al, 1989;, and hence their potential suitability for clinical pharmacological studies.…”

Hemodynamic effects of intravenous elgodipine in coronary artery disease during rest and exercise, and basic pharmacokinetic parameters

“…A commercial attenuation compensated volume flowmeter system (Quantascope, Vital Science), as described previously [9][10][11], was used to measure cardiac stroke volume (SV). The Quantascope was validated [12] and was used to assess hemodynamic drug effects [13][14][15], as described previously. This echoDoppler method has the advantage that determination of SV is independent of vessel diameter and insonation angle; the method can therefore be used during a physical activity.…”

Dose‐dependent heart rate reducing effect of nizatidine, a histamine H2‐ receptor antagonist.

“…This dual-beam Doppler echo-aortography allows the determination of cardiac output and stroke volume without the need for measuring the diameter of the ascending aorta (vessel size) and the beam-vessel angle as necessary with conventional Doppler techniques (Breithaupt et al, 1990;Donovan et al, 1987;Evans et al, 1989;Silke et al, 1990). The method for the quantascope is not discussed in detail, since this has been described previously (Mayo & Rawles, 1991;Ng et al, 1991).…”