TITLE

COMPARISON OF THE EFFECTS OF SUSTAINED-RELEASE AND SUBLINGUAL NITROGLYCERINE ON THE APEXCARDIOGRAM AND SYSTOLIC TIME INTERVALS

AUTHOR(S)
Wayne, Howard H.
PUB. DATE
March 1977
SOURCE
Angiology;Mar1977, Vol. 28 Issue 3, p190
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
The effects of a sustained-release form of nitroglycerine on left ventricular function were studied in 13 patients with ischemic heart disease in the absence of chest pain. The results were compared to those of sublingual nitroglycerine and placebo. Sustained release nitroglycerine produced a reduction in a wave amplitude on the apexcardiogram from a mean of 20% to 15% (P < 0.05) and an increase in the slope of the systolic wave from a mean of 18 mm/sec to 44 mm/sec (P < 0,01). The left ventricular ejection time corrected for heart rate (?LVET) did not change significantly, nor did the true isovolumic contraction (TIVC) time. Isovolumic relaxation (IVR) time increased from a mean of 121 msec to 137 msec (P < 0.025). The reduction in a wave amplitude and the lengthening of the IVR time reflected the fall in left ventricular end diastolic pressure. The increase in slope of the systolic wave indicated an improvement in wall motion�that is less dyskinesis in comparison to the resting recordings. In most instances these changes occurred within 1 to 2 hours, with residual effects persisting for 4 to 6 hours. Following the administration of sublingual nitroglycerine, similar changes occurred in a wave amplitudes and IVR limes, while the slope of the systolic wave increased from 24 mm/sec to 34 mm/sec. This value, however, was still significant (P < 0.01). In addition, unlike sustained-release nitroglycerine. ALVET showed a striking decrease from�26 msec to�47 msec. No change in any of the parameters studied were seen following placebo administration. These results suggest that both the sustained release and sublingual forms of nitroglycerine cause an improvement in left ventricular function and wall motion, but by different mechanisms. Sublingual nitroglycerine appears to work by causing a decrease in preload and wall tension, thereby reducing myocardial oxygen demands. Sustained-release nitroglycerine does not do this, a fact indicating perhaps a direct increase in myocardial perfusion to ischemic areas. Finally, the improvement in left ventricular function after the administration of both forms of nitroglycerine, suggests that the long-acting preparation in particular would be a useful adjunct in the treatment of patients with ischemic heart disease, even in the absence of chest pain.
ACCESSION #
16434293

 

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