Improvement in left ventricular wall motion following nitroglycerin

Area of Science:

• Cardiology
• Cardiovascular Imaging
• Pharmacology

Background:

• Left ventricular wall motion abnormalities are common in coronary artery disease (CAD).
• The effect of nitroglycerin on these abnormalities in CAD patients is not well understood.
• Nitroglycerin is frequently used for ischemic heart disease management.

Purpose of the Study:

• To evaluate the effects of sublingual nitroglycerin on left ventricular wall motion abnormalities and ejection fraction in patients with and without coronary artery disease.
• To determine if nitroglycerin can identify reversible wall motion abnormalities.

Main Methods:

• Left ventricular angiography was performed before and 6 minutes after 0.4 mg sublingual nitroglycerin administration in 25 patients.
• Patients included those with CAD, healthy individuals, and those with congestive cardiomyopathy.
• Hemodynamic parameters and ejection fraction were assessed.

Main Results:

• In 16 CAD patients, 12 had wall motion abnormalities; 7 showed improvement after nitroglycerin.
• Ejection fraction significantly increased (P<0.05) from 0.47 to 0.62 in those with improved wall motion.
• No significant improvement in wall motion or ejection fraction was observed in patients with congestive cardiomyopathy.

Conclusions:

• Sublingual nitroglycerin can improve left ventricular wall motion abnormalities and ejection fraction in some coronary artery disease patients.
• The mechanism underlying this improvement is currently unknown.
• Pre- and post-nitroglycerin ventriculography may be valuable for identifying reversible myocardial dysfunction in CAD.