Different hemodynamic actions of trinitroglycerin and isosorbide dinitrate in patients with acute myocardial infarction

Rezaković, D; Rutishauser, W.; Pavičić, Leo; Popadić, M; Bloch, A; Imhoff, Etienne

doi:10.1093/oxfordjournals.eurheartj.a061384

Cited by 13 publications

(6 citation statements)

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“…In conclusion, ISDN may be classified as a mixed agent acting on both preload and afterload, which is in agreement with earlier published results in patients (Rezakovic et al 1983).…”

Section: Discussionsupporting

confidence: 92%

The Effect of Isosorbide Dinitrate on the Arterial Vascular Bed: A Dose Response Study in Dogs

Aldershvile

Abildgaard

Eliasen

et al. 1987

Pharmacology & Toxicology

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Isosorbide dinitrate (ISDN) was infused stepwise intraarterially into the left hindlimb (5.7-364.8 micrograms/kg/min.) into six dogs. The mean local vascular resistance was decreased by 32% in the left hindlimb after a dose of up to 91.2 micrograms/kg/min. corresponding to a 1.6-fold increase in the left femoral artery blood flow, without significant changes in the control limb or central haemodynamics. The muscular blood flow in the adductor magnus muscle obtained by the Xenon washout technique remained unchanged in 6 of 7 other dogs at ISDN infusion rates of 91.2 micrograms/kg/min., indicating that the increase in femoral artery blood flow was not a consequence of increased muscular blood flow. The arterio-venous extraction fraction of radioactive microspheres was lower in the experimental leg during ISDN infusion when compared with the control leg, suggesting that AV-shunts are opened during ISDN infusion. In addition to the well-known effect on preload, the present results confirm that ISDN also acts on afterload. Thus, ISDN may be classified as a mixed agent acting on both pre- and afterload which is in agreement with some previous studies.

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“…In conclusion, ISDN may be classified as a mixed agent acting on both preload and afterload, which is in agreement with earlier published results in patients (Rezakovic et al 1983).…”

Section: Discussionsupporting

confidence: 92%

The Effect of Isosorbide Dinitrate on the Arterial Vascular Bed: A Dose Response Study in Dogs

Aldershvile

Abildgaard

Eliasen

et al. 1987

Pharmacology & Toxicology

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“…The results of this study confirmed our previous findings that NTG action is pre dominant on the preload and in second place on the afterload level [18], and clearly showed that optimal indication for NTG ad ministration are the patients in subsets I and II, i.e. those with normal or elevated pulmo nary wedge pressure and normal mean ar terial pressure and Cl.…”

Section: Discussionsupporting

confidence: 90%

Hemodynamic Mechanisms of the Effect of Nitroglycerin in Patients with Acute Myocardial Infarction

Rezaković¹,

Popadić²,

Popović³

et al. 1991

Cardiology

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We studied the hemodynamic response to intravenous nitroglycerin (NTG) in 40 patients with and without acute heart failure (hemodynamic subsets I-IV) during acute myocardial infarction. Hemodynamic measurements were performed by right heart catheterization. The results showed that NTG response influenced mainly the preload and to a lesser extent the afterload, however these changes were dependent on initial hemodynamic status. The changes in mean arterial pressure and cardiac index were predominantly related to pretreatment pulmonary wedge pressure and slightly to systemic vascular resistance. Response to NTG could be predicted with 85% probability as a decrease of pulmonary wedge pressure, with 58% probability as a decrease in mean arterial pressure and cardiac index, and with 32% probability as an increase in cardiac index and a decrease in systemic vascular resistance. These results indicate that NTG therapy could have optimal results in patients with elevated pulmonary wedge pressure and normal cardiac index, while in the subsets with low mean arterial pressure or low cardiac index potentially deleterious decrease in these values could occur. Therefore the optimal condition for use of intravenous nitroglycerin in the patients with acute heart failure is isolated pulmonary congestion.

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“…These results suggest that ISDN has a more selective action on venous vasculature than TNG. However, Rezakovic and colleagues [5], who compared TNG and ISDN in stoichiometrically equivalent doses by infusing them in a dose ratio 1:1.5 over 30 min in patients with acute myocardial infarction, found that TNG influenced predominantly pulmonary artery pressure and cardiac filling pressures, while ISDN affected cardiac output and systemic vascular resistance. They concluded that TNG is predominantly a venous dilator, while ISDN is a mixed vasodilator.…”

Section: Discussionmentioning

confidence: 99%

“…Thus nitrates decrease cardiac filling pressures relatively more than systemic vascular resistance, arterial blood pressure and cardiac output. However, there are in vitro [3,4] and in vivo [5] studies showing that various organic nitrates have different potency and selectivity in their effects on the venous and arterial beds, although the results are in part conflicting. In some situations, for example in the presence of increased myocardial oxygen consumption in association with systemic hypotension as a consequence of ischaemia-induced left ventricular failure and dilatation of the heart, it may be beneficial to give a nitrate which is more selective in its effect on the venous than on the arterial vascular bed.…”

mentioning

confidence: 99%

Vasodilator Properties of Nitroglycerin and Isosorbide Dinitrate During Cardiopulmonary Bypass †

Muikku

Hynynen

Salmenperä

et al. 1992

British Journal of Anaesthesia

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In a placebo-controlled trial, we have studied the vasodilator properties of bolus doses of nitroglycerin (TNG) and isosorbide dinitrate (ISDN) in 32 patients during cardiopulmonary bypass with a constant pump flow. Blood volume of the venous reservoir and mean arterial pressure were recorded for 10 min after drug administration to detect changes in venous capacitance and arteriolar resistance, respectively. The venous capacitance-increasing effects of TNG 200 micrograms and ISDN 1,600 micrograms were initially identical and significant at 2 and 3 min after the bolus. Thereafter, the effect of TNG began to decline, while that of ISDN remained significant until the end of the study. TNG 200 micrograms decreased arterial pressure slightly more than ISDN 1,600 micrograms, but the effect of both drugs lasted for only 1-2 min. TNG and ISDN were equipotent in increasing venous capacitance when administered in a bolus dose ratio of 1:8 during CPB, but the venodilator effect of ISDN lasted longer than that of TNG. The duration of the arteriolar dilator effect was very short with both drugs.

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Different hemodynamic actions of trinitroglycerin and isosorbide dinitrate in patients with acute myocardial infarction

Cited by 13 publications

References 0 publications

The Effect of Isosorbide Dinitrate on the Arterial Vascular Bed: A Dose Response Study in Dogs

The Effect of Isosorbide Dinitrate on the Arterial Vascular Bed: A Dose Response Study in Dogs

Hemodynamic Mechanisms of the Effect of Nitroglycerin in Patients with Acute Myocardial Infarction

Vasodilator Properties of Nitroglycerin and Isosorbide Dinitrate During Cardiopulmonary Bypass †

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