Effects of Propranolol and Nitroglycerin on Left Ventricular Performance in Patients with Coronary Arterial Disease

A novel approach has been employed to characterize the effects of a cardioactive drug on left ventricular haemodynamics and volume by simultaneously determining cardiac stroke volume (thermodilution) and left ventricular ejection fraction (nuclear probe). The effects of glyceryl trinitrate were evaluated in 12 patients with angiographically proven coronary artery disease at rest and 3, 7, 15 and 30 min following 10 mg buccal nitroglycerin (Suscard) administration. The impact of the drug on left ventricular haemodynamics and volume during exercise-induced angina was determined by repeating exercise 30 min following drug administration, at the workload that reliably induced angina during control exercise. At rest buccal nitroglycerin reduced systemic arterial pressure, cardiac and stroke volume indices, and increased heart rate. The left ventricular ejection fraction (E.F.) increased; its filling pressure together with end-diastolic and end-systolic volumes were significantly reduced. Compared with control supine-bicycle exercise, the drug reduced mean systemic arterial pressure and left ventricular filling pressure without change in cardiac and stroke volume indices. There was a smaller increase in left ventricular volume during exercise, and the fall in E.F. was attenuated. These data demonstrated differential actions of glyceryl trinitrate on left ventricular function related to the physiological state in obstructive coronary artery disease. These techniques appear to hold promise in the evaluation of the effects of other therapies on left ventricular volume in coronary artery disease.

Section: Haemodynamic Responsementioning

confidence: 99%

Effects of buccal nitrate on left ventricular haemodynamics and volume at rest and during exercise‐induced angina.

Silke¹,

Verma²,

Frais³

et al. 1985

“…The actions of nitrates have been widely investigated in ischaemic heart disease. Nitrates consistently reduce left ventricular filling pressure in patients with coronary artery disease, but the resultant left ventricular function response has been variable (Christensson et al, 1965;McAnulty et al, 1975;Najmi et al, 1967;Parker et al, 1971;Schwarz et al, 1977;Shah et al, 1976;Slutsky et al, 1983;Steel et al, 1978 (1985) demonstrated that buccal NTG (10 mg) reduced pulmonary artery occluded pressure (-3 mm Hg) and cardiac stroke volume at rest, but on exercise cardiac stroke volume was maintained despite a greater reduction in occluded pressure (-13 mm Hg). A reduction in cardiac performance indices after buccal NTG occurred in the present study in that there was a fall in cardiac stroke volume, stroke length and time-averaged aortic velocity.…”

Section: Difference Between Drugs and Placebomentioning

confidence: 99%

“…P-adrenoceptor blocking drugs have been usually followed by dose-dependent reduction in cardiac performance Svendsen et al, 1979;Taylor et al, 1982). The major haemodynamic action of nitroglycerine (NTG) is a reduction in left ventricular filling pressure; this has been reported to result in variable alterations in cardiac output and stroke volume (McAnulty et al, 1975;Schwarz et al, 1977;Shah etal., 1976;Slutsky et al, 1983;Steel et al, 1978;Williams etal., 1975). The effects of buccal NTG on invasively measured haemodynamics in patients with coronary artery disease have been previously described (Silke et al, 1985).…”

Section: Introductionmentioning

confidence: 99%

Pharmacodynamic monitoring during acute intervention in ischaemic heart disease using a new echo‐Doppler device.

Silke

Verma

1990

Infirmary at Leeds, Leeds 1 We have utilised a new non-imaging echo-Doppler cardiac output device, using the principle of attenuated compensated volume flow (ACVF), to assess the cardiovascular effects of atenolol and buccal nitroglycerine (NTG) in a placebo-controlled study of 30 patients with coronary disease. 2 Atenolol (4 mg i.v.) reduced heart rate, cardiac output and time-averaged mean aortic velocity (P < 0.01) and increased systemic vascular resistance (P < 0.01). 3 Buccal NTG (5 mg) reduced systemic mean arterial pressure (P < 0.01), cardiac stroke volume (P < 0.05) and stroke length (P < 0.01). 4 Thus although both drugs reduced time-averaged aortic velocity (an index of cardiac performance), the concomitant reduction in cardiac stroke length and tachycardia suggested sub-optimal cardiac filling for buccal NTG, whereas for atenolol (with the associated increased systemic vascular resistance but unchanged stroke length) attenuation of sympathetic stimulation at cardiac P-adrenoceptors.S The ACVF method of cardiovascular monitoring should prove useful in human pharmacodynamic studies.

“…In contrast the published literature has shown that nitrates consistently reduce left ventricular filling pressure in patients with coronary artery disease, but the resultant impact on cardiac pumping has been variable (Christenson et 1965; Najmi et al, 1967;Parker et al, 1971;McAnulty et al, 1975;Shah etal., 1976;Schwartz et al, 1977;Steele et al, 1978;Slutsky et al, 1983). Shah et al (1976) Najmi et al (1967) and are of interest in that they show the dependence of the actions of nitrate on the absolute level of the left ventricular.…”

Section: Haemodynamic Effectsmentioning

confidence: 99%

A rest and exercise haemodynamic evaluation of a new cardio‐selective beta‐adrenoceptor blocker celiprolol alone and in combination with nitroglycerine in ischaemic heart disease.

Silke¹,

Verma²,

Frais³

et al. 1986

1 The symptomatic benefits of combining ,-adrenoceptor blockers and nitrates in angina pectoris are well recognised. Their actions on cardiac haemodynamics and volumes when combined have been poorly characterized. Accordingly this study investigated a new cardioselective ,-adrenoceptor blocking agent celiprolol and buccal nitroglycerine in 24 patients with angiographically documented coronary artery disease. 2 Following a control period, with confirmed stable haemodynamics, three groups (n = 8/group) of prospectively matched patients, were studied following intravenous celiprolol (8 mg), buccal nitrate (10 mg) or their combination. Haemodynamics and left ventricular ejection fraction (nuclear probe) were determined following each intervention. The actions of each regimen on the haemodynamics of exercise-induced angina were compared by exercise testing in the control state and following each regimen. 3 At rest, celiprolol did not alter haemodynamic parameters. Nitrate therapy reduced left ventricular filling pressure (pulmonary artery occluded pressure-PAOP) and volumes; the ejection fraction and heart rate increased. Combination therapy resulted in a highly significant reduction in left ventricular preload and afterload (PAOP and mean arterial blood pressure) at an increased left ventricular ejection fraction and reduced cardiac volumes; there was a trend to reduce cardiac double product (HR x SBP). 4 During exercise celiprolol reduced systolic blood pressure, heart rate and cardiac index; systemic vascular resistance index increased. Nitrate therapy reduced blood pressure and PAOP, and increased ejection fraction. Combination therapy reduced all components of the triple product (heart rate, systolic blood pressure and PAOP) without affecting the other haemodynamic or radionuclide parameters. 5 These data suggest improvements in cardiac function from the combination of celiprolol and nitrate therapy which were not achieved by either agent when used as monotherapy; they afford an interesting insight into the manner in which such widely utilised therapeutic modalities interact in coronary artery disease.