Effect of nitroglycerin on left ventricular function in patients with ischemic heart disease

To evaluate the effects of nitroglycerin on left ventricular function in 27 patients with ischemic heart disease, ejection fraction (EF) was measured every 1 to 5 min by a nuclear stethoscope after sublingual administration of nitroglycerin (0.3 mg). There was a good correlation between EF determined by the nuclear stethoscope and EF by left ventriculography (r = 0.80, p less than 0.001). EF showed a rise after sublingual nitroglycerin, which was most marked at 4 to 7 min and returned to the control level in 20 to 25 min. There were no significant differences in the maximum percent increase in EF among patients with 0, 1, 2 and 3 vessel disease. The maximum percent increases in EF were 34.0 +/- 10.0% in the normal contraction group, 24.0 +/- 8.5% in the hypokinesis group (p less than 0.05 vs the normal contraction group) and 15.2 +/- 8.5% in the akinesis group (p less than 0.01 vs the normal contraction group, p less than 0.05 vs the hypokinesis group). There was a weak correlation between the maximum percent increase in EF and the changes in heart rate (r = 0.49, p less than 0.05) and there was an inverse correlation between the maximum percent increase in EF and the changes in systolic blood pressure (r = -0.65, p less than 0.01). It was shown that the improvement in EF by sublingual nitroglycerin was greatest in the normal contraction group, somewhat less in the hypokinesis group and least in the akinesis group. The nuclear stethoscope is useful in monitoring changes in left ventricular function during intervention.