Effects of Nitroglycerin on Regional Myocardial Blood Flow in Coronary Artery Disease

Horwitz, Lawrence D.; Gorlin, Richard; Taylor, Warren J.; Kemp, Harvey G.

doi:10.1172/jci106645

Cited by 143 publications

(27 citation statements)

References 18 publications

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“…", 16 Coronary flows at rest in coronary disease patients were not significantly different than in subjects with normal coronary arteries, supporting observations in other patient groups. "-"' Indices of coronary resistance were slightly higher in the coronary disease patients than in normal coronary subjects, as expected.15…”

Section: Discussionsupporting

confidence: 58%

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

Mehta¹,

Pepine²

1978

Circulation

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SUMMARY We evaluated the effects of sublingual nitroglycerin on indices of regional coronary flow and coronary resistance (CR) in 12 selected patients with coronary artery disease (CAD) and eight with normal coronary arteries (NCA), using continuous thermodilution. Resting total left ventricular flow, reflected by coronary sinus flow (CSF), and anterior regional flow, reflected by great cardiac vein flow (GCVF), in NCA and CAD patient groups, were similar. However, in a subgroup of six patients, with CAD limited to the anterior descending artery, GCVF was lower and anterior regional CR (CRANT) higher than the NCA subjects. Nitroglycerin reduced the systolic pressure-heart rate product similarly in both patient groups. CSF and GCVF in NCA subjects declined 15% and 17%, respectively, as total CR (CRT) and CRANT increased. In the CAD subgroup, consisting of patients with CAD limited to the anterior descending, GCVF increased 48% as CRANT declined 50%, and CSF was unchanged. In the other CAD subgroup of patients with CAD in the right and/or circumflex arteries, GCVF declined 32% and CRANT increased 46% as CSF was minimally increased.These data imply that sublingual nitroglycerin reduces both CSF and GCVF in NCA patients as oxygen demands decrease. In certain CAD patients, however, nitroglycerin alters regional coronary venous blood flow, suggesting a redistribution of flow from normally perfused to hypoperfused regions.

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Section: Discussionsupporting

confidence: 58%

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

Mehta¹,

Pepine²

1978

Circulation

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“…8 (14,21,(23)(24)(25)(26), radioisotopic determination of collateral flow (15,23,24,(27)(28)(29)(30), and microsphere determination of flow distribution (31 (5), and therefore the special conditions of our protocol must not be overlooked. Collateral vessels in the dog heart are often epicardial, whereas these vessels tend to be intramural in man (38 (18).…”

Section: Resultsmentioning

confidence: 99%

“…A biphasic effect of TNG on coronary blood flow is supported by carefully controlled studies in animals (11)(12)(13). Moreover, a direct dilatory effect of TNG on coronary collaterals in dog (14) and man (15) has been shown, although the significance of the direct coronary effects of TNG is undermined by the recent report that only intravenous and not intracoronary administration of TNG is effective in the relief of angina in man (5 (6.6 French) was embolized into the LAD with a coaxial catheter system introduced into a femoral artery. The catheter system consisted of an outer red Kifa catheter and an inner Teflon catheter extending beyond the end of the former and carrying a hollow, tapered Kifa plug.…”

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confidence: 99%

The Effects of Nitroglycerin on Coronary Collaterals and Myocardial Contractility

Cohen¹,

Downey²,

Sonnenblick³

et al. 1973

J. Clin. Invest.

132

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A B S T R A C T Nitroglycerin (TNG) causes a prolonged dilatation of coronary collaterals. To demonstrate a functional significance of this dilatation we measured the effect of TNG on myocardial contractile force in dogs 2j-4 wk after the left anterior descending coronary artery (LAD) had been embolized in closed-chest animals. Development of collaterals was documented by angiography. Via a left thoracotomy the main left coronary artery (LCA) and LAD distal to the embolized plug were cannulated. Coronary flow and perfusion pressure were recorded. Contractile force was measured with gauges sutured to epicardial areas supplied by the left circumflex coronary artery (LCf) and occluded LAD. Coronary perfusion pressure in the LCA was gradually decreased until the contractile force recorded by the LAD gauge diminished while the LCf gauge was unaffected. Under these conditions, with coronary perfusion pressure held constant with the aid of a Starling resistance, TNG (18 ,g) injected into the LCA increased peripheral LAD pressure by 3-12 mm Hg and contractile force in the LAD region by 36% (range 20-90%), returning it to near-normal levels, while having minimal effect in the LCf area. These changes persisted for 5 min. When LCf and LAD areas were both ischemic, intracoronary TNG had minimal effect on peripheral LAD pressure and contractile force. Thus, TNG causes prolonged dilatation of coronary collaterals and presumed increased collateral flow with subsequent enhancement of myocardial contractile force in ischemic areas. This effect is seen only when ischemia is limited to an area supplied by the collaterals. When the whole heart is This study was presented in part at the 22nd Annual

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“…The post-ONTG data represent the point of maximum reduction of L VFP and the temporally associated hemodynamic effects for each patient. In four patients L VFP remained elevated (18)(19)(20)(21)(22)(23)(24)(25)(26)(27) mm Hg) after significant (p < 0.05) reduction from initial levels (25-36 mm Hg) by ONTG (Group I, Table II). Cardiac index, stroke index and stroke work index increased in each of these patients and rose significantly for the group (Table II and Fig.…”

Section: Resultsmentioning

confidence: 93%

Sustained salutary effects of oral controlled‐release nitroglycerin on ventricular function in congestive heart failure

Amsterdam

Awan

DeMaria

et al. 1979

Clinical Cardiology

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The hemodynamic effects of a controlled‐release preparation of original nitroglycerin (ONTG), 6.5 mg to 19.5 mg, were determined during a four hour period in 10 patients with left ventricular failure. After ONTG ingestion left ventricular filling pressure (LVFP) diminished in 20 min (23 to 17 mm Hg, p < 0.01), declined maximally within one hour (15 mm Hg, p < 0.001) and remained decreased (p < 0.02) throughout the four hours. For the entire group no significant alterations (p > 0.05) occurred in systolic blood pressure, heart rate, cardiac index (CI) and peripheral vascular resistance (PVR). However, two subgroups were identified relative to ONTG hemodynamic response. In the four patients in whom LVFP declined but remained substantially elevated (29 to 23 mm Hg, p < 0.05), CI rose (1.7 to 2.1 l/min/m2, p < 0.01) while PVR fell (2074 to 1571 dyne · s · cm‐5, p < 0.02). In contrast, in the six patients with LVFP reductions to 12 mm Hg or less (18 to 10 mm Hg, p < 0.005), CI was unchanged (2.2, p > 0.05) without alteration of PVR (1799, p > 0.05). This investigation provides objective evidence of the salutary hemodynamic effects of ONTG and confirms adequate gastrointestinal absorption with attainment of pharmacologically active blood levels. Moreover, oral sustained‐release nitroglycerin is shown to possess long‐acting peripheral vasodilator actions of considerable value in the treatment of congestive heart failure.

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Effects of Nitroglycerin on Regional Myocardial Blood Flow in Coronary Artery Disease

Cited by 143 publications

References 18 publications

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

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

The Effects of Nitroglycerin on Coronary Collaterals and Myocardial Contractility

Sustained salutary effects of oral controlled‐release nitroglycerin on ventricular function in congestive heart failure

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