Effect of propranolol on left ventricular function, segmental wall motion, and diastolic pressure-volume relation in man.

Abstract

Precise quantitation of the effects of the non-selective beta adrenergic blocking drug propranolol (O.I5 mg/kg body weight) on left ventricularfunction, segmental wall motion, and diastolic pressure-volume relation in man has been performed. High fidelity left ventricular pressure measurements and simultaneous single-plane angiocardiograms were recorded on a video disc and volumes calculated by a light-pen computer system. Systolic segmental wall motion was computer analysed using the long axis-quadrasection method. Patients were transvenously atrially paced to maintain a constant heart rate.The haemodynamic effects ofpropranolol may vary depending upon the extent of pre-existing myocardial disease. In some patients ventricular function, as measured by ejection fraction, may be reduced. This reduction in ejection fraction appears to result from overall reduction in segmental wall motion, but also from accentuation of segmental wall abnormalities. These results are consistent with the thesis that beta adrenergic blocking drugs may inhibit compensatory sympathetic mechanisms.The diastolic effects of propranolol may include quite substantial increases in ventricular volumes in those patients with impaired cardiac function. With respect to the intact human ventricle, propranolol may increase diastolic volume for a given level of ventricular pressure. Thus, in a static sense, the ventricle in these patients could be viewed as being more compliant after propranolol administration. However, the fact that the lengthtension relation, as measured by the slope of the logarithmic pressure versus volume plot is unaltered by propranolol, suggests that the muscle comprising the ventricle itself exhibits no alteration in its passive elastic properties.The non-selective beta-adrenergic blocking drug propranolol is widely used in clinical practice for the treatment of patients with ischaemic heart disease, hypertension, arrhythmias, and obstructive cardiomyopathy.Many haemodynamic studies have been reported in the past documenting the effects of propranolol on ventricular function. Because propranolol has a strong negative chronotropic effect, it has not always been possible in these studies to isolate the direct

Alteration of diastolic filling rate during exercise radionuclide angiography: a highly sensitive technique for detection of coronary artery disease.

“…[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] This study sought to characterize the alterations in performance of the heart in delivering an increased stroke volume and in diastolic filling during stress and how these parameters of left ventricular performance might be altered by ischemia.…”

“…3 Diastolic performance has been demonstrated to be very sensitive to ischemia. [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] Careful assessment of diastolic properties during stress, however, has not been previously well characterized by radionuclide angiography, and might prove to enhance the sensitivity of detection of ischemia. We therefore sought to evaluate and characterize the detection of ischemic heart disease by alteration in diastolic as well as systolic parameters during exercise.…”

Factors which affect the diastolic pressure-volume curve.

“…This direct action of filling pressure provides the mechanism by which agents that increase blood pressure shift the pressurevolume curve up 10 and agents that drop blood pressure drop it. 10 " 13 In particular, Alderman and Glantz 10 showed that angiotensin not only increased left ventricular enddiastolic pressure and aortic pressure, but also right ventricular pressure; nitroprusside dropped all three. Shirato et al 87 showed, in dogs, that shifts in the diastolic pressure-diameter curve with nitroprusside only occur with the pericardium closed.…”

Different Effects of Propranolol, Phenylephrine, and Saline Volume Loading on Catecholamine-Induced Left Ventricular Outflow Tract Obstruction in Acute Coronary Syndrome

“…For example, propranolol administration resulted in decreased heart rate, elevated blood pressure, and reduced pulmonary artery pressure, while phenylephrine administration resulted in elevated blood pressure, decreased heart rate, and increased cardiac output, and saline volume loading resulted in increased cardiac output and elevated blood pressure. Effects of propranolol: Previous studies have suggested that catecholamineinduced LVOT in the context of ACS resulted from compensative hyperkinesis of the nonischemic LVOT and the inferoposterior segment [1][2][3][4][5] and that the negative inotropic effect of propranolol can attenuate the enhanced hyperdynamic motion of the nonischemic LV segments 9) and thereby result in reversal of LVOT obstruction. 6) Further, reversal of LVOT obstruction may induce a paradoxical increase in cardiac output and systemic blood pressure and thereby decrease diastolic LV filling pressure and pulmonary artery pressure.…”