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. 1990 Jun;29(6):741–747. doi: 10.1111/j.1365-2125.1990.tb03696.x

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

B Silke 1, S P Verma 1, S H Taylor 1
PMCID: PMC1380177  PMID: 2116160

Abstract

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 nitroglycerin (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 less than 0.01) and increased systemic vascular resistance (P less than 0.01). 3. Buccal NTG (5 mg) reduced systemic mean arterial pressure (P less than 0.01), cardiac stroke volume (P less than 0.05) and stroke length (P less than 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 beta-adrenoceptors. 5. The ACVF method of cardiovascular monitoring should prove useful in human pharmacodynamic studies.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. CHRISTENSSON B., KARLEFORS T., WESTLING H. HAEMODYNAMIC EFFECTS OF NITROGLYCERIN IN PATIENTS WITH CORONARY HEART DISEASE. Br Heart J. 1965 Jul;27:511–519. doi: 10.1136/hrt.27.4.511. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Donovan K. D., Dobb G. J., Newman M. A., Hockings B. E., Ireland M. Comparison of pulsed Doppler and thermodilution methods for measuring cardiac output in critically ill patients. Crit Care Med. 1987 Sep;15(9):853–857. doi: 10.1097/00003246-198709000-00011. [DOI] [PubMed] [Google Scholar]
  3. Elkayam U., Gardin J. M., Berkley R., Hughes C. A., Henry W. L. The use of Doppler flow velocity measurement to assess the hemodynamic response to vasodilators in patients with heart failure. Circulation. 1983 Feb;67(2):377–383. doi: 10.1161/01.cir.67.2.377. [DOI] [PubMed] [Google Scholar]
  4. Evans J. M., Skidmore R., Baker J. D., Wells P. N. A new approach to the noninvasive measurement of cardiac output using an annular array Doppler technique--II. Practical implementation and results. Ultrasound Med Biol. 1989;15(3):179–187. doi: 10.1016/0301-5629(89)90062-8. [DOI] [PubMed] [Google Scholar]
  5. Evans J. M., Skidmore R., Luckman N. P., Wells P. N. A new approach to the noninvasive measurement of cardiac output using an annular array Doppler technique--I. Theoretical considerations and ultrasonic fields. Ultrasound Med Biol. 1989;15(3):169–178. doi: 10.1016/0301-5629(89)90061-6. [DOI] [PubMed] [Google Scholar]
  6. Gisvold S. E., Brubakk A. O. Measurement of instantaneous blood-flow velocity in the human aorta using pulsed Doppler ultrasound. Cardiovasc Res. 1982 Jan;16(1):26–33. doi: 10.1093/cvr/16.1.26. [DOI] [PubMed] [Google Scholar]
  7. Goldberg S. J., Sahn D. J., Allen H. D., Valdes-Cruz L. M., Hoenecke H., Carnahan Y. Evaluation of pulmonary and systemic blood flow by 2-dimensional Doppler echocardiography using fast Fourier transform spectral analysis. Am J Cardiol. 1982 Dec;50(6):1394–1400. doi: 10.1016/0002-9149(82)90481-7. [DOI] [PubMed] [Google Scholar]
  8. Hendry W. G., Silke B., Taylor S. H. Haemodynamic dose-response effects of i.v. metoprolol in coronary heart disease. Eur J Clin Pharmacol. 1981;19(5):323–327. doi: 10.1007/BF00544581. [DOI] [PubMed] [Google Scholar]
  9. Hottinger C. F., Meindl J. D. Blood flow measurement using the attenuation-compensated volume flowmeter. Ultrason Imaging. 1979 Jan;1(1):1–15. doi: 10.1177/016173467900100101. [DOI] [PubMed] [Google Scholar]
  10. Huntsman L. L., Stewart D. K., Barnes S. R., Franklin S. B., Colocousis J. S., Hessel E. A. Noninvasive Doppler determination of cardiac output in man. Clinical validation. Circulation. 1983 Mar;67(3):593–602. doi: 10.1161/01.cir.67.3.593. [DOI] [PubMed] [Google Scholar]
  11. Ihlen H., Amlie J. P., Dale J., Forfang K., Nitter-Hauge S., Otterstad J. E., Simonsen S., Myhre E. Determination of cardiac output by Doppler echocardiography. Br Heart J. 1984 Jan;51(1):54–60. doi: 10.1136/hrt.51.1.54. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Loeppky J. A., Hoekenga D. E., Greene E. R., Luft U. C. Comparison of noninvasive pulsed Doppler and Fick measurements of stroke volume in cardiac patients. Am Heart J. 1984 Feb;107(2):339–346. doi: 10.1016/0002-8703(84)90384-3. [DOI] [PubMed] [Google Scholar]
  13. McAnulty J. H., Hattenhauer M. T., Rösch J., Kloster F. E., Rahimtoola S. H. Improvement in left ventricular wall motion following nitroglycerin. Circulation. 1975 Jan;51(1):140–145. doi: 10.1161/01.cir.51.1.140. [DOI] [PubMed] [Google Scholar]
  14. Najmi M., Griggs D. M., Jr, Kasparian H., Novack P. Effects of nitroglycerin on hemodynamics during rest and exercise in patients with coronary insufficiency. Circulation. 1967 Jan;35(1):46–54. doi: 10.1161/01.cir.35.1.46. [DOI] [PubMed] [Google Scholar]
  15. Parker J. O., West R. O., Di Giorgi S. Hemodynamic effects of propranolol in coronary heart disease. Am J Cardiol. 1968 Jan;21(1):11–19. doi: 10.1016/0002-9149(68)90007-6. [DOI] [PubMed] [Google Scholar]
  16. Parker J. O., West R. O., Di Giorgi S. The effect of nitroglycerin on coronary blood flow and the hemodynamic response to exercise in coronary artery disease. Am J Cardiol. 1971 Jan;27(1):59–65. doi: 10.1016/0002-9149(71)90083-x. [DOI] [PubMed] [Google Scholar]
  17. Schwarz F., Ensslen R., Thormann J., Schlepper M. Abolished compensation of cardiac performance after nitroglycerin in patients with ventricular asynergy. Am Heart J. 1977 Oct;94(4):421–427. doi: 10.1016/s0002-8703(77)80034-3. [DOI] [PubMed] [Google Scholar]
  18. Shah R., Bodenheimer M. M., Banka V. S., Helfant R. H. Nitroglycerin and ventricular performance. Differential effect in the presence of reversible and irreversible asynergy. Chest. 1976 Oct;70(4):473–479. doi: 10.1378/chest.70.4.473. [DOI] [PubMed] [Google Scholar]
  19. Silke B., Hilal A., Taylor S. H. Haemodynamic dose-response effects of intravenous oxprenolol in coronary heart disease. J Cardiovasc Pharmacol. 1981 Jul-Aug;3(4):716–727. doi: 10.1097/00005344-198107000-00006. [DOI] [PubMed] [Google Scholar]
  20. Silke B., Verma S. P., Frais M. A., Hafizullah M., Taylor S. H. Effects of buccal nitrate on left ventricular haemodynamics and volume at rest and during exercise-induced angina. Br J Clin Pharmacol. 1985 Nov;20(5):437–445. doi: 10.1111/j.1365-2125.1985.tb05094.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Silke B., Zezulka A. V., Verma S. P., Taylor S. H. Hemodynamic assessment of nicardipine alone and with atenolol in coronary artery disease using a modified echo-Doppler device. Am J Cardiol. 1989 Oct 17;64(15):28H–34H. doi: 10.1016/0002-9149(89)90978-8. [DOI] [PubMed] [Google Scholar]
  22. Slutsky R., Watkins J., Costello D. Radionuclide evaluation of the systolic blood pressure/end-systolic volume relationship: response to pharmacologic agents in patients with coronary artery disease. Am Heart J. 1983 Jan;105(1):53–59. doi: 10.1016/0002-8703(83)90278-8. [DOI] [PubMed] [Google Scholar]
  23. Steele P. P., Maddoux G., Kirch D. L., Vogel R. A. Effects of propranolol and nitroglycerin on left ventricular performance in patients with coronary arterial disease. Chest. 1978 Jan;73(1):19–23. doi: 10.1378/chest.73.1.19. [DOI] [PubMed] [Google Scholar]
  24. Svendsen T. L., Hartling O., Trap-Jensen J. Immediate haemodynamic effects of propranolol, practolol, pindolol, atenolol and ICI 89,406 in healthy volunteers. Eur J Clin Pharmacol. 1979 May 21;15(4):223–228. doi: 10.1007/BF00618509. [DOI] [PubMed] [Google Scholar]
  25. Taylor S. H., Silke B. Is the measurement of cardiac output useful in clinical practice? Br J Anaesth. 1988;60(8 Suppl 1):90S–98S. doi: 10.1093/bja/60.suppl_1.90s. [DOI] [PubMed] [Google Scholar]
  26. Taylor S. H., Silke B., Lee P. S., Hilal A. Haemodynamic dose-response effects of intravenous beta-blocking drugs with different ancillary properties in patients with coronary heart disease. Eur Heart J. 1982 Dec;3(6):564–569. doi: 10.1093/oxfordjournals.eurheartj.a061353. [DOI] [PubMed] [Google Scholar]
  27. Voyles W. F., Greene E. R., Miranda I. P., Reilly P. A., Caprihan A. Observer variability in serial noninvasive measurements of stroke index using pulsed Doppler flowmetry. Biomed Sci Instrum. 1982;18:67–75. [PubMed] [Google Scholar]
  28. Williams D. O., Amsterdam E. A., Mason D. T. Hemodynamic effects of nitroglycerin in acute myocardial infarction. Circulation. 1975 Mar;51(3):421–427. doi: 10.1161/01.cir.51.3.421. [DOI] [PubMed] [Google Scholar]

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