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Radionuclide assessment of ventricular performance during propranolol withdrawal prior to aortocoronary bypass
Insights
Oral propranolol did not significantly impact left ventricular ejection fraction or ejection rate in patients with coronary artery disease undergoing surgery. Heart rate increased upon withdrawal, but cardiac performance remained stable.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Coronary artery disease (CAD) affects left ventricular (LV) function.
- Propranolol is a beta-blocker used in cardiovascular conditions.
- The impact of propranolol withdrawal on LV performance in CAD patients is not fully understood.
Purpose of the Study:
- To assess the effects of oral propranolol withdrawal on left ventricular performance in patients with coronary artery disease.
- To evaluate changes in ejection fraction, ejection rate, and regional wall motion during propranolol tapering.
Main Methods:
- First-pass radionuclide angiocardiography was used to assess LV function.
- 18 patients with CAD undergoing elective aortocoronary bypass surgery were studied.
- Patients were evaluated at peak propranolol dose, intermediate dose, and after discontinuation.
Main Results:
- Heart rate increased significantly during propranolol withdrawal (p < 0.001).
- Systolic blood pressure, ejection fraction, and ejection rate showed no significant changes (p > 0.05).
- No patient exhibited altered regional wall motion upon propranolol withdrawal.
Conclusions:
- Common clinical dosages of oral propranolol do not significantly affect baseline radionuclide measures of left ventricular performance in patients with CAD.
- Propranolol withdrawal does not appear to compromise LV function in the studied population.
- Further research may explore effects under stress conditions.
Abstract:
The effects of oral propranolol upon left ventricular performance were assessed in 18 patients with angiographically documented coronary artery disease in whom propranolol was tapered prior to elective aortocoronary bypass surgery. Left ventricular ejection fraction, ejection rate, and regional wall motion were obtained on three occasions with first-pass radionuclide angiocardiographic techniques. Patients were studied at peak propranolol dose ( +/- SEM) 224 +/- 29 mg./day; serum propranolol level, 85 +/- 22 ng./ml.), intermediate dose (99 +/- 9 mg./day; serum propranolol, 30 +/- 6 ng./ml.), and 24 hours following discontinuation of propranolol therapy. Heart rate increased significantly (62 +/- 2.3 vs 67 +/- 3.0 vs 73 +/- 2.3 beats/minute, p less than 0.001) during propranolol withdrawal, while systolic blood pressure did not change significantly (114.7 +/- 4.3 vs 110.3 +/-3.0 vs 113 +/- 3.0 mm. Hg, p greater than 0.05). There was no significant change in ejection fraction (59.1 +/- 2.4 vs 60.4 +/- 2.0 vs 59.2 +/- 2.5 per cent) or ejection rate 2.80 +/- 0.18 vs 2.87 +/- 0.18 vs 2.92 +/- 0.20 sec.-1) as propranolol was tapered (p greater than 0.05). No patient demonstrated a change in regional wall motion in response to propranolol withdrawal. The results of this study suggest that oral propranolol in commonly used clinical dosages does not significantly affect radionuclide measures of left ventricular performance in the basal state.
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