Nitrates in aortic valve disease: acute and chronic effects

The beneficial effect of Nitroglycerin (NTG) on myocardial oxygen-supply-demand ratio in severe aortic stenosis has been already demonstrated. But the chronic administration of isosorbide dinitrate (ISDN) does not reduce the increase in left ventricular filling pressures during exercise. Therefore in severe aortic stenosis, the effects of chronic nitrate administration on left ventricular hemodynamics during exercise do not correspond to the beneficial acute effects of NTG. In aortic insufficiency, sublingual NTG has only minor effects on left ventricular volumes, heart rate and cardiac output. A moderate reduction in pressures results in a significant reduction of wall stress, while there is no major change in regurgitant fraction.