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Regional left ventricular wall dynamics before and after sublingual administration of nitroglycerin

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      Abstract

      Regional wall dynamics of the left ventricle before and after sublingual administration of 0.6 mg of nitroglycerin were determined from left ventricular angiograms in 27 patients undergoing coronary arteriography. Regional wall dynamics were quantitatively measured from 60/sec determinations of wall thickness and derived peak rate of systolic wall thickening (peak dTw/dt) in selected sites of the left ventricle. A total of 70 regions were studied. Analysis of the same segment before and after administration of nitroglycerin revealed that the mean change in peak dTw/dt was +1.97 cm/sec in segments with an initial peak dTw/dt of less than 5 cm/sec, in contrast to a change of +0.66 cm/sec in segments with an initial control value of 5 cm/sec or greater. Akinetic or dyskinetic areas did not show improvement after nitroglycerin. In 11 left ventriculograms, an area that was initially hypokinetic manifested an increase in rate of wall thickening after nitroglycerin. The mean increase in peak dTw/dt in anterior segments with electrocardiographic evidence of myocardial infarction was 0.18 cm/sec (P <0.05) after nitroglycerin, compared with a mean change of 1.33 cm/sec in anterior segments without such evidence. This study presents evidence for a regional myocardial response to nitroglycerin with differing responses within the same ventricle apparently depending upon the functional state of the underlying myocardium.
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      References

        • Chiong MA
        • West RO
        • Parker JO
        Influence of nitroglycerin on myocardial metabolism and hemodynamics during angina induced by atrial pacing.
        Circulation. 1972; 45: 1044-1056
        • Frick MH
        • Balcon R
        • Cross D
        • et al.
        Hemodynamic effects of nitroglycerin in patients with angina pectoris studied by an atrial pacing method.
        Circulation. 1968; 37: 160-168
        • Parker JO
        • Di Giorgi S
        • West RO
        A hemodynamic study of acute coronary insufficiency precipitated by exercise: with observations on the effects of nitroglycerin.
        Am J Cardiol. 1966; 17: 470-483
        • Cowan C
        • Duran PVM
        • Corsini G
        • et al.
        The effects of nitroglycerin on myocardial blood flow in man: measured by coincidence counting and bolus injection of 84rubidium.
        Am J Cardiol. 1969; 24: 154-160
        • Knoebel SB
        • McHenry PL
        • Bonner AJ
        • et al.
        Myocardial blood flow in coronary artery disease: effect of right atrial pacing and nitroglycerin.
        Circulation. 1973; 47: 690-696
        • Winbury MM
        • Howe BB
        • Weiss HR
        Effect of nitroglycerin and dipyridamole on epicardial and endocardial oxygen tension—further evidence for redistribution of myocardial blood flow.
        J Pharmacol Exp Ther. 1971; 176: 184-199
        • Dumesnil JG
        • Ritman EL
        • Frye RL
        • et al.
        Quantitative determination of regional left ventricular wall dynamics by roentgen videometry.
        Circulation. 1974; 50: 700-708
        • Ritman EL
        • Sturm RE
        • Wood EH
        Biplane roentgen videometric system for dynamic (60/sec) studies of the shape and size of circulatory structures, particularly the left ventricle.
        Am J Cardiol. 1973; 32: 180-187
        • Sturm RE
        • Ritman EL
        • Hansen R
        • et al.
        Recording of multichannel analog data and video images on the same video tape or disc.
        J Appl Physiol. 1974; 36: 761-764
        • Brown R
        • Rahimtoola SH
        • Davis GD
        • et al.
        The effect of angiocardiographic contrast medium on circulatory dynamics in man: cardiac output during angiocardiography.
        Circulation. 1965; 31: 234-240
        • Rahimtoola SH
        • Duffy JP
        • Swan HJC
        Ventricular performance after angiocardiography.
        Circulation. 1967; 35: 70-78
        • Herman MV
        • Heinle RA
        • Klein MD
        • et al.
        Localized disorders in myocardial contraction: asynergy and its role in congestive heart failure.
        N Engl J Med. 1967; 277: 222-232
        • Herman MV
        • Gorlin R
        Implications of left ventricular asynergy.
        Am J Cardiol. 1969; 23: 538-547
        • Belousov SS
        • Gorkina ME
        • Malakhova MA
        Myocardial asynergy in ischemic heart disease and influence of nitroglycerin.
        Kardiologia. 1972; 12: 64-67
        • Helfant RH
        • Pine R
        • Meister SG
        • et al.
        Nitroglycerin to unmask reversible asynergy: correlation with post coronary bypass ventriculography.
        Circulation. 1974; 50: 108-113
        • Dwyer EM
        Left ventricular pressure-volume alterations and regional disorders of contraction during myocardial ischemia induced by atrial pacing.
        Circulation. 1970; 42: 1111-1122
        • Helfant RH
        • Herman MV
        • Gorlin R
        Abnormalities of left ventricular contraction induced by beta adrenergic blockade.
        Circulation. 1971; 43: 641-647
        • Dove JT
        • Shah PM
        • Schreiner BF
        Effects of nitroglycerin on left ventricular wall motion in coronary artery disease.
        Circulation. 1974; 49: 682-687
        • Abel RM
        • Reis RL
        Effects of coronary blood flow and perfusion pressure on left ventricular contractility in dogs.
        Circ Res. 1970; 27: 961-971
        • Forman R
        • Kirk ES
        • Downey JM
        • et al.
        Nitroglycerin and heterogeneity of myocardial blood flow: reduced subendocardial blood flow and ventricular contractile force.
        J Clin Invest. 1973; 52: 905-911
        • Rowe GC
        • Chellus CJ
        • Afonso S
        • et al.
        Systemic and coronary hemodynamic effects of erythrol tetranitrate.
        J Clin Invest. 1961; 40: 1217-1222