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Effects of nitroglycerine on coronary flow velocity before and during adenosine provocation

Ann Wittfeldt1,2, Anders Jeppsson3,4, Li-Ming Gan3,5

  • 1Dept of Molecular and Clinical Medicine, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, 41345, Gothenburg, Sweden. ann.wittfeldt@gu.se.

Cardiovascular Ultrasound
|December 7, 2016
PubMed

Insights

Pretreating with nitroglycerine before adenosine infusion significantly improves coronary microvascular function assessment. This suggests adenosine alone causes submaximal hyperemia, impacting coronary flow velocity reserve measurements.

Area of Science:

  • Cardiology
  • Vascular Physiology
  • Diagnostic Imaging

Background:

  • Coronary flow velocity reserve (CFVR) assessed by transthoracic echocardiography evaluates coronary microvascular arterial function.
  • Adenosine infusion is used to induce hyperemia for CFVR calculation, but its maximal response is uncertain.
  • Nitroglycerine pretreatment is hypothesized to enhance hyperemia induced by adenosine.

Purpose of the Study:

  • To determine if nitroglycerine pretreatment enhances hyperemia during adenosine-induced stress for CFVR measurement.
  • To assess the effect of nitroglycerine on coronary artery diameter and baseline/hyperemic flow velocities.

Main Methods:

  • Twenty-three healthy subjects underwent CFVR measurements.
  • Sublingual nitroglycerine (0.5 mg) was administered before adenosine infusion (140 μg/kg/min).
  • Left main coronary artery diameter was measured to assess nitroglycerin's effect.

Main Results:

  • Nitroglycerine pretreatment significantly increased median CFVR (3.6 to 5.0, p=0.002).
  • This increase was due to reduced baseline coronary flow velocity (17 to 27 cm/s, p<0.0001), while hyperemic velocity remained unchanged (p=0.48).
  • Nitroglycerin significantly dilated the left main coronary artery (3.1 mm to 3.8 mm, p=0.018).

Conclusions:

  • Nitroglycerine pretreatment dilates coronary arteries and enhances CFVR.
  • Adenosine infusion alone appears to induce submaximal hyperemia.
  • This finding has implications for accurate assessment of coronary microvascular function.
Abstract

Keywords:
Coronary flow velocity reserveNitroglycerineNon-invasiveUltrasound

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