Effects of intravenously administered propranolol on wall motion abnormalities

Ludbrook, Philip A.; Karliner, Joel S.; Kostuk, William J.; O’Rourke, Robert A.

doi:10.1016/0002-9149(73)90005-2

Cited by 23 publications

(3 citation statements)

References 13 publications

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“…1,2 In normal subjects, beta-blockers can decrease circumferential fiber shortening, and decrease the velocity of wall motion. 3,4 However, even in these subjects, EF increases with exercise. 1 In patients with cardiomyopathy, resting EF often increases after starting beta-blockers.…”

Section: Discussionmentioning

confidence: 92%

Beta Adrenergic Receptor Blockade Causing Severe Left Ventricular Systolic Dysfunction during Dobutamine Stress Echocardiography in a Patient with No Structural Heart Disease

Okada

Bonow

2011

Echocardiography

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A 41-year-old woman with a history of neurocardiogenic syncope treated with beta-blockers was admitted with chest pain. Dobutamine echocardiogram images demonstrated decreased global LV systolic wall motion and thickening. Coronary angiograms were normal. Beta-blockers were stopped and dobutamine stress echocardiogram (DSE) was repeated. Dobutamine images demonstrated increased global LV systolic wall motion and thickening. Beta-blockers were restarted and again dobutamine produced global LV dysfunction. This case suggests that DSE wall motion response may be falsely abnormal in a patient on beta-blockers. Physicians should be aware of this possibility when interpreting dobutamine echocardiography in patients taking beta-blockers.

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Section: Discussionmentioning

confidence: 92%

Beta Adrenergic Receptor Blockade Causing Severe Left Ventricular Systolic Dysfunction during Dobutamine Stress Echocardiography in a Patient with No Structural Heart Disease

Okada

Bonow

2011

Echocardiography

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“…2). The boundaries of the asynergic segment were defined by an excursion of less Ludbrook e l al than 3 mm during systole [29]. A linear measuring device (Keufel & Essen) was then utilized to determine the length of the asynergic segment and the length of the entire diastolic circumference.…”

Section: Discussionmentioning

confidence: 99%

“…Although the primary cardiac and peripheral vascular responses to isometric exercise are generally considered to be mediated by the sympathetic nervous system, both we and others have observed either augmentation or deterioration of left ventricular contractile function in different patients [ 1-31. To clarify the mechanisms responsible for these disparate left ventricular functional responses in individual patients exposed to isometric exercise, we studied, in 29 patients stratified according to left ventricular function, the effects of handgrip on left ventricular systolic and diastolic function during diagnostic cardiac catheterization.…”

Section: Introductionmentioning

confidence: 99%

The relationship between left ventricular functional response to isometric exercise and asynergic contraction and diastolic stiffness

Ludbrook

Gowda

Tiefenbrunn

et al. 1982

Cathet. Cardiovasc. Diagn.

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Either augmentation or impairment of left ventricular function has previously been reported in different patients, in response to isometric exercise. To identify the mechanisms associated with these disparate responses, the effects of submaximal sustained handgrip upon left ventricular systolic and diastolic properties were studied in 29 patients during diagnostic catheterization. In 16 patients (group I), ejection fraction, mean Vcf, and the mean systolic ejection rate remained constant, while the ratio of peak systolic pressure to end systolic volume increased significantly from 2.81 +/- 0.6 to 3.17 +/- 0.6 ml/mm Hg. In 13 patients (group II) ejection fraction declined from 0.6 +/- 0.03 to 0.51 +/- 0.03, Vcf from 0.96 +/- 0.09 to 0.85 +/- 0.09 circ/sec, mean normalized systolic ejection rate from 1.79 +/- 0.1 to 1.50 +/- 0.09 sec-1, and the peak systolic pressure to end systolic volume ratio from 2.23 +/- 0.3 to 1.99 +/- 0.3 (p less than 0.05 for each). Systemic arterial mean pressure increased similarly by 19% and 21% in groups I and II, respectively (p less than 0.05 for each). Systemic vascular resistance increased significantly by 23% in group I and by 5% in group II (p less than 0.05). Left ventricular end diastolic volume declined from 85.4 +/- 7 to 77.3 +/- 11 ml/m2 in group I, while end diastolic and end systolic volumes increased by 13% and 35%, respectively in group II (p less than 0.05 for each). In both groups, baseline exponential pressure-volume relations were similar, though higher intercepts on the pressure-volume relations upon the Y-axis suggested greater "diastolic tone," and steeper volume-normalized pressure-volume elasticity relations indicated "stiffer" left ventricular chambers in group II patients. While the incidence of coronary artery disease was similar, both the severity and extent of left ventricular asynergy were greater in group II patients. We conclude that dilatation and deterioration of left ventricular ejection function in response to isometric exercise are causally related to, and comprise a useful predictor of, severe underlying left ventricular asynergy and impaired chamber distensibility.

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Characterization of left ventricular external wall motion in man by video dimension analyzer (Vidian)

Ludbrook

Yin

Peterson

1977

Cathet. Cardiovasc. Diagn.

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Several investigators have described close relationships between left ventricular wall motion and physiologic cardiac events. Using an improved wall motion tracking devide (Vidian) in studies of 30 patients, we have compared the dynamics of left ventricular wall motion, recorded noninvasively, with high fidelity left ventricular and aortic pressures, intracardiac phonocardiograms, apexcardiograms, and cyclic left ventricular volume curves obtained during cardiac catheterization. Wall motion tracking signals comprised: pre-ejection outward deflection commencing with the first component of the first heart sound and coincident with the pre-ejection phase of the left ventricular pressure and apexcardiogram; a sharp descent during ejection, commencing with the "E" point of the apexcardiogram and with the onset of the upstroke of the aortic pressure; end ejection nadir, synchronous with the dicrotic notch of the aortic pressure; a nadir representing cessation of inward displacement, presumably reflecting slight inertial motion of the wall; a brief period of isovolumic relaxation which terminated synchronously with the "O" point of the apexcardiogram; rapid, then slow filling waves, coincident with those of the apexcardiogram, and demarcated by a transitional angulation synchronous with the third heart sound; and "a" wave, occurring simultaneously with that of the apexcardiogram. Ventricular wall motion tracking signals also corresponded to curves representing cyclic changes in left ventricular minor radius, and chamber volume derived from cineventriculograms. In 10 patients with abnormal contraction patterns detected by biplane cineventriculography, anomalous deflections were also recorded during ejection by the Vidian. Left ventricular wall motion tracking with the Vidian: 1) provides a sensitive index for timing of intracardiac events, 2) reflects cyclic changes in ventricular volumes and minor dimensions, 3) provides a convenient noninvasive technique for detection of regional asynergy involving the lateral left ventricular wall, and 4) by correlation with simultaneous ventricular pressure measurements, may provide useful information regarding left ventricular pressure/segment dimension relations.

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Effects of intravenously administered propranolol on wall motion abnormalities

Cited by 23 publications

References 13 publications

Beta Adrenergic Receptor Blockade Causing Severe Left Ventricular Systolic Dysfunction during Dobutamine Stress Echocardiography in a Patient with No Structural Heart Disease

Beta Adrenergic Receptor Blockade Causing Severe Left Ventricular Systolic Dysfunction during Dobutamine Stress Echocardiography in a Patient with No Structural Heart Disease

The relationship between left ventricular functional response to isometric exercise and asynergic contraction and diastolic stiffness

Characterization of left ventricular external wall motion in man by video dimension analyzer (Vidian)

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