Effect of sublingual nitroglycerin on regional flow in patients with and without coronary disease.

Mehta, Jayesh; Pepine, Carl J.

doi:10.1161/01.cir.58.5.803

Cited by 83 publications

(12 citation statements)

References 23 publications

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“…6,15,16 The functional impairment of a vessel is probably better assessed by measuring flow reserve. Invasive studies have shown that when maximal coronary dilatation is induced, blood flow or blood flow velocity increases more in normal vessels than in those affected by significant stenosis.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Left Internal Mammary Artery Graft Patency by Transthoracic Doppler Echocardiography

Elmasry

Salama

Darwish

et al. 2002

Clinical Cardiology

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SummaryBackground: The successful application of noninvasive Doppler spectrum analysis has been reported for the hemodynamic assessment of LIMA graft after myocardial revascularization.Hypothesis: The objective of this study was to assess the utility of transthoracic Doppler echocardiography (TTE) in providing information on LIMA flow in patients after coronary artery bypass graft surgery.Methods: In all, 22 patients (aged 62 ± 8 years) with LIMA graft to the left anterior descending (LAD) coronary artery who underwent coronary angiography were assessed using high-frequency (5 MHz) transthoracic Doppler echocardiography. They were compared with 25 patients with angina (control group A, aged 59 ± 12 years), in whom an ungrafted LIMA was assessed, and with 17 patients (control group B, aged 59 ± 9 years) with angiographically normal coronary arteries, in whom the LAD was assessed.Results: A biphasic pattern (systolic and diastolic) was recorded in all cases. In 14 patients with a normal graft or < 70% stenosis (Group 1) and in control group B, blood flow was maximal during diastole. In eight patients with severe graft stenosis > 70% (Group 2) and control group B, blood flow was maximal during systole, with low diastolic flow. The diastolic fraction of the velocity time integrals was 0.81 ± 0.11 for Group 1 and 0.25 ± 0.06 for Group 2 (p < 0.05). A diastolic velocity time integral fraction < 0.5 predicted > 70% stenosis

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Section: Discussionmentioning

confidence: 99%

Assessment of Left Internal Mammary Artery Graft Patency by Transthoracic Doppler Echocardiography

Elmasry

Salama

Darwish

et al. 2002

Clinical Cardiology

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“…[12][13][14] In addition, all of these drugs are thought to induce a redistribution of coronary blood flow between normal and ischemic myocardium, and some may also have direct protective effects on the myocardium." [15][16][17][18][19][20][21] Because the ischemia in patients with coronary artery disease is regional, major interest has been directed to the study of regional differences in myocardial perfusion and function. Investigations in conscious experimental animals with chronic coronary arterial stenosis indicated that exercise causes severe regional myocardial dysfunction and hemodynamic abnormalities.…”

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confidence: 99%

Comparative effects of nitroglycerin, nifedipine and metoprolol on regional left ventricular function in patients with one-vessel coronary disease.

Pfisterer¹,

Glaus²,

Burkart³

1983

Circulation

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SUMMARY To compare acute effects of nitroglycerin (0.8 mg sublingually), nifedipine (5 ng/kg/min i.v.) and metoprolol (0.15 mg/kg i.v.) on normal, ischemic and scarred myocardial segments in man, we performed simultaneous hemodynamic and radionuclide measurements of left ventricular function. Sixteen patients with isolated left anterior descending (LAD) disease were studied at rest and during exercise. Nine patients had angina and exercise-induced ischemia (LAD stenosis) and seven patients had previous transmural myocardial infarction and no ischemic changes during thallium imaging (LAD occlusion). The effects of the drugs on regional ejection fraction of the involved anteroseptal region and the normal posterolateral area were compared.Global ejection fraction at rest did not change after nitroglycerin, increased after nifedipine and decreased after metoprolol. In patients with ischemia, the exercise ejection fraction improved after all drugs due to increased regional ejection fraction in ischemic segments; i.e., a regional antiischemic effect evidenced by improved regional function could be demonstrated with all three agents. Regional ejection fraction increased from 35.8 + 19.5% to 66.2 ± 15.2% (± SD) after nitroglycerin (p < 0.001), to 61.7 ± 8.7% after nifedipine (p < 0.001), and to 48.4 ± 7.0% after metoprolol (p < 0.01). In regions of myocardial scar, regional ejection fraction was not changed after any drug. In normal areas, regional ejection fraction remained unchanged after nitroglycerin and nifedipine, but decreased after metoprolol. Despite similar antiischemic effects of all three drugs, underlying hemodynamic mechanisms were quite different and may provide a rationale for combined forms of treatment. These results may help to select optimal drug combinations to improve myocardial performance in patients with chronic ischemic heart disease.

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“…' " By reducing intraventricular diastolic pressure, it improves the transmural distribution of myocardial perfusion by reducing extrinsic diastolic compression of the subendocardial vessels. 6 No 6, DECEMBER 1981 rest pain with associated ST-segment depression. Premedication was usually avoided; all cardiac medications were discontinued at least 10 hours before the procedure.…”

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confidence: 99%

The mechanisms of nitroglycerin action: stenosis vasodilatation as a major component of the drug response.

Brown¹,

Bolson²,

Petersen³

et al. 1981

Circulation

445

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SUMMARY The effect of sublingual or intracoronary nitroglycerin (NTG) on luminal caliber in normal and diseased portions of epicardial coronary arteries was determined in 85 lesions from 57 typical patients with ischemic heart disease. Measurements were made from coronary angiograms, using a computer-assisted method and a carefully blinded protocol for analysis of the pre-and post-NTG angiograms. Luminal area in the "normal" portion of the diseased segment and at its maximum constriction and an estimate of flow resistance in the stenosis were computed. Luminal area increased 1.27 mm2 (p < 0.001) in the "normal" regions, an average increase of 18% over the control area. Dilation with NTG depended strongly on vessel size; area increased 35% in normal vessels of 1.6-2.3 mm luminal diameter and only 9% in vessels 4.0-5.0 mm in diameter. Lesions were grouped into four levels of severity by percent stenosis. Minimum luminal area increased 0.35 mm2 (p < 0.01) at the narrowest point in moderate lesions, a 22% area increase, and 0.14 mm2 (p < 0.001) in severe lesions, a 36% area increase. Stenosis dilation resulted in an average 25% reduction (p < 0.01) in estimated stenosis flow resistance in moderate lesions and a 38% reduction (p < 0.001) in severe lesions. A statistically significant resistance reduction of greater than 20% occurred in 15 of 20 severe stenoses; only two of 20 showed no measurable dilation. We reviewed recent literature on hemodynamic responses to NTG and determined that changes of this magnitude are among the largest reported. We conclude that vasodilation of epicardial coronary stenoses is usually a major component of the beneficial response to NTG.We support that conclusion by demonstrating a striking improvement in ischemic left ventricular compliance abnormalities after low-dose intracoronary NTG. NITROGLYCERIN (NTG) affords dramatic relief of angina pectoris in patients with coronary artery disease; yet its mechanisms of action are complex and, in certain respects, controversial. NTG is said to reduce the myocardial oxygen requirement by diminishing systolic wall tension through reduced systemic pressure (afterload) and reduced left ventricular (LV) diastolic pressure and cavity size (preload

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Effect of sublingual nitroglycerin on regional flow in patients with and without coronary disease.

Cited by 83 publications

References 23 publications

Assessment of Left Internal Mammary Artery Graft Patency by Transthoracic Doppler Echocardiography

Assessment of Left Internal Mammary Artery Graft Patency by Transthoracic Doppler Echocardiography

Comparative effects of nitroglycerin, nifedipine and metoprolol on regional left ventricular function in patients with one-vessel coronary disease.

The mechanisms of nitroglycerin action: stenosis vasodilatation as a major component of the drug response.

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