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

Goldstein, Robert E.; Bennett, E. D.; Leech, G L

doi:10.1136/hrt.42.3.245

Cited by 25 publications

(3 citation statements)

References 22 publications

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“…The mechanisms by which nitrates are purported to exert their antianginal effect are numerous, with effects on preload, afterload, and myocardial perfusion being described. 3 – 7 …”

mentioning

confidence: 99%

Physiology of Angina and Its Alleviation With Nitroglycerin

et al. 2017

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“…The mechanisms by which nitrates are purported to exert their antianginal effect are numerous, with effects on preload, afterload, and myocardial perfusion being described. 3 – 7 …”

mentioning

confidence: 99%

Physiology of Angina and Its Alleviation With Nitroglycerin

et al. 2017

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“…The drug, by its effects on venous and arteriolar dilatation, reduces resting ventricular volume in both the supine and upright postures (Williams et al, 1965;Hoeschen et al, 1966;Burggraf and Parker, 1974). In a recent echocardiographic study, glyceryl trinitrate reduced ventricular volume during sitting bicycle exercise (Goldstein et al, 1977). Glyceryl trinitrate consistently reduces left ventricular diastolic pressure at rest and during exercise (Parker et al, 1971), and this should facilitate subendocardial perfusion.…”

Section: Discussionmentioning

confidence: 99%

Influence of glyceryl trinitrate during supine and upright exercise in patients with angina pectoris.

Thadani¹,

Parker²

1978

Heart

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SUMMARY The clinical, electrocardiographic, and circulatory effects of 0-6 mg sublingual glyceryl trinitrate were studied at rest and during treadmill and supine bicycle exercise in 16 patients with angina pectoris. Before glyceryl trinitrate, all patients experienced angina during both exercise periods. However, the heart rate and rate pressure product at angina were higher during treadmill than during supine bicycle exercise. This is considered to be the result of diminished left ventricular volume and oxygen requirements in the upright posture.At rest after glyceryl trinitrate, systolic blood pressure fell and heart rate rose in each posture, the effects being more pronounced in the standing position. During exercise, when the rate pressure product at the onset of angina before glyceryl trinitrate was compared with the rate pressure product at the same work load after glyceryl trinitrate, there was no significant difference in either position (treadmill, 192 ± 10 vs 203 ± 9; supine, 185 ± 9 vs 182 ± 8 mmHg/min x 10-2). However, in comparison with the control values before glyceryl trinitrate, exercise duration to angina after glyceryl trinitrate increased significantly in each posture. The rate pressure product at angina after glyceryl trinitrate increased significantly in comparison with the rate pressure product at angina during the control studies in each posture. The improvement in exercise tolerance and increase in rate pressure product after glyceryl trinitrate were similar during both upright and supine exercise. This could be interpreted as evidence for the predominant influence of glyceryl trinitrate on coronay perfusion but it is possible that similar changes in ventricular volume during exercise occurred in both positions.Patients with angina pectoris have better exercise tolerance and achieve higher rate pressure products in the upright than in the supine posture (Lecerof, 1971;Bygdeman and Wahren, 1974). This probably reflects reduced left ventricular volume with resultant decrease in wall tension and myocardial oxygen requirements for any given rate pressure product in the upright posture. This is supported by the observation that left ventricular filling pressures during exertional angina are lower during upright than during supine exercise (Thadani et al., 1977). Glyceryl trinitrate, by its venous and arteriolar effects (Mason and Braunwald, 1965), reduces left ventricular volume (Burggraf and Parker, 1974) which should be more pronounced in the upright position. Thus, one might expect that

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“…The 10 subjects lay supine on a table in a slightly left lateral position and were fixed at the shoulder level. They pedalled a bicycle ergometer at 60 revolutions/min.…”

Section: Bicycle Exercise Stress Testmentioning

confidence: 99%

Left ventricular function at similar heart rates during tachycardia induced by exercise and atrial pacing: an echocardiographic study.

Piérard¹,

Serruys²,

Roelandt³

et al. 1987

Heart

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SUMMARY M mode echocardiography was used in 10 normal subjects to study left ventricular dimension and function variables at identical heart rates during tachycardia induced by supine bicycle exercise or atrial pacing. Echocardiographic data were analysed independently by two observers. The maximum heart rate reached during atrial pacing was lower (mean (1 SD) 148 (17) beats/min) than that reached during exercise (mean (1SD) 167 (14) beats/min). The left ventricular end diastolic dimension was greater before supine exercise than before atrial pacing, probably as a result of leg raising. At each graded exercise step the end diastolic dimension remained greater than during atrial pacing and the differences became progressively greater with increasing heart rates. The left ventricular end systolic dimension was not significantly different at each step during the two stresses. During recovery the end systolic dimension was significantly smaller after exercise than at corresponding heart rates induced by atrial pacing. Left ventricular function indices-fractional shortening and peak rates of left ventricular systolic and diastolic dimensional change-were significantly higher during exercise than during atrial pacing and the differences increased with heart rate.It is concluded that (a) the intervention used to change heart rate has an important effect on M mode echocardiographic left ventricular dimensions; (b) indices of left ventricular performance increase progressively during exercise and differ from those measured at the same heart rate during atrial pacing; (c) it is important to consider heart rate, stroke volume, and loading conditions when reference values are used and when the effects of a particular stress are to be interpreted.Adaptation of the cardiovascular system to dynamic exercise results from integrated mechanisms including an increase in heart rate and contractility, changes in preload and afterload, and a decrease in peripheral resistance.1 Echocardiography permits non-invasive assessment of left ventricular size and Requests for reprints to Dr Luc A Pierard,

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

Cited by 25 publications

References 22 publications

Physiology of Angina and Its Alleviation With Nitroglycerin

Physiology of Angina and Its Alleviation With Nitroglycerin

Influence of glyceryl trinitrate during supine and upright exercise in patients with angina pectoris.

Left ventricular function at similar heart rates during tachycardia induced by exercise and atrial pacing: an echocardiographic study.

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