Skip to main content
NCBI home page
British Journal of Clinical Pharmacology logoLink to British Journal of Clinical Pharmacology
. 1985 Nov;20(5):437–445. doi: 10.1111/j.1365-2125.1985.tb05094.x

Effects of buccal nitrate on left ventricular haemodynamics and volume at rest and during exercise-induced angina.

B Silke, S P Verma, M A Frais, M Hafizullah, S H Taylor
PMCID: PMC1400711  PMID: 3935147

Abstract

A novel approach has been employed to characterize the effects of a cardioactive drug on left ventricular haemodynamics and volume by simultaneously determining cardiac stroke volume (thermodilution) and left ventricular ejection fraction (nuclear probe). The effects of glyceryl trinitrate were evaluated in 12 patients with angiographically proven coronary artery disease at rest and 3, 7, 15 and 30 min following 10 mg buccal nitroglycerin (Suscard) administration. The impact of the drug on left ventricular haemodynamics and volume during exercise-induced angina was determined by repeating exercise 30 min following drug administration, at the workload that reliably induced angina during control exercise. At rest buccal nitroglycerin reduced systemic arterial pressure, cardiac and stroke volume indices, and increased heart rate. The left ventricular ejection fraction (E.F.) increased; its filling pressure together with end-diastolic and end-systolic volumes were significantly reduced. Compared with control supine-bicycle exercise, the drug reduced mean systemic arterial pressure and left ventricular filling pressure without change in cardiac and stroke volume indices. There was a smaller increase in left ventricular volume during exercise, and the fall in E.F. was attenuated. These data demonstrated differential actions of glyceryl trinitrate on left ventricular function related to the physiological state in obstructive coronary artery disease. These techniques appear to hold promise in the evaluation of the effects of other therapies on left ventricular volume in coronary artery disease.

Full text

PDF
437

Selected References

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

  1. Bacharach S. L., Green M. V., Borer J. S., Ostrow H. G., Redwood D. R., Johnston G. S. ECG-gated scintillation probe measurement of left ventricular function. J Nucl Med. 1977 Dec;18(12):1176–1183. [PubMed] [Google Scholar]
  2. Berger H. J., Davies R. A., Batsford W. P., Hoffer P. B., Gottschalk A., Zaret B. L. Beat-to-beat left ventricular performance assessed from the equilibrium cardiac blood pool using a computerized nuclear probe. Circulation. 1981 Jan;63(1):133–142. doi: 10.1161/01.cir.63.1.133. [DOI] [PubMed] [Google Scholar]
  3. 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]
  4. Crawford M. H., White D. H., Amon K. W. Echocardiographic evaluation of left ventricular size and performance during handgrip and supine and upright bicycle exercise. Circulation. 1979 Jun;59(6):1188–1196. doi: 10.1161/01.cir.59.6.1188. [DOI] [PubMed] [Google Scholar]
  5. Feild B. J., Russell R. O., Jr, Dowling J. T., Rackley C. E. Regional left ventricular performance in the year following myocardial infarction. Circulation. 1972 Oct;46(4):679–689. doi: 10.1161/01.cir.46.4.679. [DOI] [PubMed] [Google Scholar]
  6. Folland E. D., Parisi A. F., Moynihan P. F., Jones D. R., Feldman C. L., Tow D. E. Assessment of left ventricular ejection fraction and volumes by real-time, two-dimensional echocardiography. A comparison of cineangiographic and radionuclide techniques. Circulation. 1979 Oct;60(4):760–766. doi: 10.1161/01.cir.60.4.760. [DOI] [PubMed] [Google Scholar]
  7. Forrester J. S., Ganz W., Diamond G., McHugh T., Chonette D. W., Swan H. J. Thermodilution cardiac output determination with a single flow-directed catheter. Am Heart J. 1972 Mar;83(3):306–311. doi: 10.1016/0002-8703(72)90429-2. [DOI] [PubMed] [Google Scholar]
  8. Ganz W., Swan H. J. Measurement of blood flow by thermodilution. Am J Cardiol. 1972 Feb;29(2):241–246. doi: 10.1016/0002-9149(72)90635-2. [DOI] [PubMed] [Google Scholar]
  9. Hoel B. L. Some aspects of the clinical use of thermodilution in measuring cardiac output. With particular reference to the Swan-Ganz thermodilution catheters. Scand J Clin Lab Invest. 1978 Jun;38(4):383–388. doi: 10.3109/00365517809108438. [DOI] [PubMed] [Google Scholar]
  10. Konstam M. A., Wynne J., Holman B. L., Brown E. J., Neill J. M., Kozlowski J. Use of equilibrium (gated) radionuclide ventriculography to quantitate left ventricular output in patients with and without left-sided valvular regurgitation. Circulation. 1981 Sep;64(3):578–585. doi: 10.1161/01.cir.64.3.578. [DOI] [PubMed] [Google Scholar]
  11. Lahiri A., Bowles M. J., Jones R. I., Crawley J. C., Raftery E. B. Assessment of left ventricular function in coronary artery disease with the nuclear probe during intervention studies. Br Heart J. 1984 Oct;52(4):422–430. doi: 10.1136/hrt.52.4.422. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Links J. M., Becker L. C., Shindledecker J. G., Guzman P., Burow R. D., Nickoloff E. L., Alderson P. O., Wagner H. N. Measurement of absolute left ventricular volume from gated blood pool studies. Circulation. 1982 Jan;65(1):82–91. doi: 10.1161/01.cir.65.1.82. [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. McCarthy D. M., Makler P. T., Jr Accuracy of left ventricular ejection fraction using the nuclear stethoscope in left ventricular aneurysm. Am J Cardiol. 1985 Jan 1;55(1):177–180. doi: 10.1016/0002-9149(85)90323-6. [DOI] [PubMed] [Google Scholar]
  15. McKay R. G., Aroesty J. M., Heller G. V., Royal H., Parker J. A., Silverman K. J., Kolodny G. M., Grossman W. Left ventricular pressure-volume diagrams and end-systolic pressure-volume relations in human beings. J Am Coll Cardiol. 1984 Feb;3(2 Pt 1):301–312. doi: 10.1016/s0735-1097(84)80013-3. [DOI] [PubMed] [Google Scholar]
  16. 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]
  17. Okada R. D., Pohost G. M., Kirshenbaum H. D., Kushner F. G., Boucher C. A., Block P. C., Strauss H. W. Radionuclide-determined change in pulmonary blood volume with exercise. Improved sensitivity of multigated blood-pool scanning in detecting coronary-artery disease. N Engl J Med. 1979 Sep 13;301(11):569–576. doi: 10.1056/NEJM197909133011102. [DOI] [PubMed] [Google Scholar]
  18. 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]
  19. Rackley C. E., Dear H. D., Baxley W. A., Jones W. B., Dodge H. T. Left ventricular chamber volume, mass, and function in severe coronary artery disease. Circulation. 1970 Apr;41(4):605–613. doi: 10.1161/01.cir.41.4.605. [DOI] [PubMed] [Google Scholar]
  20. Schiller N. B., Acquatella H., Ports T. A., Drew D., Goerke J., Ringertz H., Silverman N. H., Brundage B., Botvinick E. H., Boswell R. Left ventricular volume from paired biplane two-dimensional echocardiography. Circulation. 1979 Sep;60(3):547–555. doi: 10.1161/01.cir.60.3.547. [DOI] [PubMed] [Google Scholar]
  21. 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]
  22. 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]
  23. Slutsky R., Karliner J., Ricci D., Kaiser R., Pfisterer M., Gordon D., Peterson K., Ashburn W. Left ventricular volumes by gated equilibrium radionuclide angiography: a new method. Circulation. 1979 Sep;60(3):556–564. doi: 10.1161/01.cir.60.3.556. [DOI] [PubMed] [Google Scholar]
  24. 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]
  25. Sorensen M. B., Bille-Brahe N. E., Engell H. C. Cardiac output measurement by thermal dilution: reproducibility and comparison with the dye-dilution technique. Ann Surg. 1976 Jan;183(1):67–72. doi: 10.1097/00000658-197601000-00014. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. 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]
  27. Wagner H. N., Wake R., Nickoloff E., Natarajan T. K. The nuclear stethoscope: a simple device for generation of left ventricular volume curves. Am J Cardiol. 1976 Nov 23;38(6):747–750. doi: 10.1016/0002-9149(76)90352-0. [DOI] [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]

Articles from British Journal of Clinical Pharmacology are provided here courtesy of British Pharmacological Society

RESOURCES