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. 1979 Sep;42(3):245–254. doi: 10.1136/hrt.42.3.245

Effect of glyceryl trinitrate on echocardiographic left ventricular dimensions during exercise in the upright position.

R E Goldstein, E D Bennett, G L Leech
PMCID: PMC482143  PMID: 116668

Abstract

Changes in left ventricular size may be of importance in the development of angina and in its amelioration by glyceryl trinitrate, but left ventricular dimensions have not been measured during exercise in the upright position, the circumstance in which angina most often occurs. To assess changes in left ventricular end-systolic and end-diastolic dimensions, echocardiograms were obtained from 5 normal subjects and 6 patients with angina during rest and exercise upright, both before and after glyceryl trinitrate. The end-systolic dimension was considered an index of regional performance rather than an estimate of overall left ventricular behaviour. During exercise the end-diastolic dimension rose both in the normal subjects and in the patients. The end-systolic dimension fell progressively with exercise in the normal subjects but changed inconsistently in the patients. Glyceryl trinitrate lowered the end-diastolic dimension during exercise below comparable pretreatment values in both groups; the glyceryl trinitrate-induced decrease in end-diastolic dimension in the patients diminished at higher exercise levels. In all normal subjects and in 4 of the 6 patients with normal systolic shortening (= end-diastolic--end-systolic dimension) glyceryl trinitrate caused relatively small changes in the end-systolic dimension and systolic shortening on exercise. In contrast, in the 2 patients with hypokinetic ventricles glyceryl trinitrate conspicuously decreased the end-systolic dimension and increased systolic shortening. Thus, during exercise, in the normal subjects and in the patients with normally functioning left ventricles on echocardiography, glyceryl trinitrate caused a modest fall in the end-diastolic dimension and little change in the end-systolic dimension, but in patients with ventricular hypokinesia it greatly improved regional contractile performance. Alleviation of ischaemic hypokinesia during exercise may be an important part of the benefit of glyceryl trinitrate.

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Selected References

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

  1. Borer J. S., Bacharach S. L., Green M. V., Kent K. M., Epstein S. E., Johnston G. S. Real-time radionuclide cineangiography in the noninvasive evaluation of global and regional left ventricular function at rest and during exercise in patients with coronary-artery disease. N Engl J Med. 1977 Apr 14;296(15):839–844. doi: 10.1056/NEJM197704142961503. [DOI] [PubMed] [Google Scholar]
  2. Borer J. S., Bacharach S. L., Green M. V., Kent K. M., Johnston G. S., Epstein S. E. Effect of nitroglycerin on exercise-induced abnormalities of left ventricular regional function and ejection fraction in coronary artery disease. Assessment by radionuclide clineagiography in symptomatic and asymptomatic patients. Circulation. 1978 Feb;57(2):314–320. doi: 10.1161/01.cir.57.2.314. [DOI] [PubMed] [Google Scholar]
  3. Burggraf G. W., Parker J. O. Left ventricular volume changes after amyl nitrite and nitroglycerin in man as measured by ultrasound. Circulation. 1974 Jan;49(1):136–143. doi: 10.1161/01.cir.49.1.136. [DOI] [PubMed] [Google Scholar]
  4. DeMaria A. N., Vismara L. A., Auditore K., Amsterdam E. A., Zelis R., Mason D. T. Effects of nitroglycerin on left ventricular cavitary size and cardiac performance determined by ultrasound in man. Am J Med. 1974 Nov;57(5):754–760. doi: 10.1016/0002-9343(74)90849-3. [DOI] [PubMed] [Google Scholar]
  5. Goldstein R. E., Rosing D. R., Redwood D. R., Beiser G. D., Epstein S. E. Clinical and circulatory effects of isosorbide dinitrate. Comparison with nitroglycerin. Circulation. 1971 May;43(5):629–640. doi: 10.1161/01.cir.43.5.629. [DOI] [PubMed] [Google Scholar]
  6. Helfant R. H., Pine R., Meister S. G., Feldman M. S., Trout R. G., Banka V. S. Nitroglycerin to unmask reversible asynergy. Correlation with post coronary bypass ventriculography. Circulation. 1974 Jul;50(1):108–113. doi: 10.1161/01.cir.50.1.108. [DOI] [PubMed] [Google Scholar]
  7. Henry W. L., Clark C. E., Epstein S. E. Asymmetric septal hypertrophy. Echocardiographic identification of the pathognomonic anatomic abnormality of IHSS. Circulation. 1973 Feb;47(2):225–233. doi: 10.1161/01.cir.47.2.225. [DOI] [PubMed] [Google Scholar]
  8. Kjekshus J. K. Mechanism for flow distribution in normal and ischemic myocardium during increased ventricular preload in the dog. Circ Res. 1973 Nov;33(5):489–499. doi: 10.1161/01.res.33.5.489. [DOI] [PubMed] [Google Scholar]
  9. MONROE R. G. MYOCARDIAL OXYGEN CONSUMPTION DURING VENTRICULAR CONTRACTION AND RELAXATION. Circ Res. 1964 Apr;14:294–300. doi: 10.1161/01.res.14.4.294. [DOI] [PubMed] [Google Scholar]
  10. 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]
  11. Parker J. O., Di Giorgi S., West R. O. A hemodynamic study of acute coronary insufficiency precipitated by exercise. With observations on the effects of nitroglycerin. Am J Cardiol. 1966 Apr;17(4):470–483. doi: 10.1016/0002-9149(66)90237-2. [DOI] [PubMed] [Google Scholar]
  12. Ratshin R. A., Rackley C. E., Russell R. O., Jr Determination of left ventricular preload and afterload by quantitative echocardiography in man. Circ Res. 1974 May;34(5):711–718. doi: 10.1161/01.res.34.5.711. [DOI] [PubMed] [Google Scholar]
  13. Redwood D. R., Henry W. L., Epstein S. E. Evaluation of the ability of echocardiography to measure acute alterations in left ventricular volume. Circulation. 1974 Nov;50(5):901–904. doi: 10.1161/01.cir.50.5.901. [DOI] [PubMed] [Google Scholar]
  14. Redwood D. R., Rosing D. R., Goldstein R. E., Beiser G. D., Epstein S. E. Importance of the design of an exercise protocol in the evaluation of patients with angina pectoris. Circulation. 1971 May;43(5):618–628. doi: 10.1161/01.cir.43.5.618. [DOI] [PubMed] [Google Scholar]
  15. Sharma B., Goodwin J. F., Raphael M. J., Steiner R. E., Rainbow R. G., Taylor S. H. Left ventricular angiography on exercise. A new method of assessing left ventricular function in ischaemic heart disease. Br Heart J. 1976 Jan;38(1):59–70. doi: 10.1136/hrt.38.1.59. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Sniderman A. D., Herscovitch P., Marpole D., Fallen E. L. Restoration of regional wall motion by nitroglycerin therapy in patients with left ventricular asynergy. Chest. 1974 Nov;66(5):545–548. doi: 10.1378/chest.66.5.545. [DOI] [PubMed] [Google Scholar]
  17. Sonnenblick E. H., Braunwald E., Williams J. F., Jr, Glick G. Effects of exercise on myocardial force-velocity relations in intact unanesthetized man: relative roles of changes in heart rate, sympathetic activity, and ventricular dimensions. J Clin Invest. 1965 Dec;44(12):2051–2062. doi: 10.1172/JCI105312. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Theroux P., Ross J., Jr, Franklin D., Kemper W. S., Sasyama S. Regional Myocardial function in the conscious dog during acute coronary occlusion and responses to morphine, propranolol, nitroglycerin, and lidocaine. Circulation. 1976 Feb;53(2):302–314. doi: 10.1161/01.cir.53.2.302. [DOI] [PubMed] [Google Scholar]
  19. Williams J. F., Jr, Glick G., Braunwald E. Studies on cardiac dimensions in intact unanesthetized man. V. Effects of nitroglycerin. Circulation. 1965 Nov;32(5):767–771. doi: 10.1161/01.cir.32.5.767. [DOI] [PubMed] [Google Scholar]

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