Effect of sublingual nitroglycerin on left ventricular function at rest and during spontaneous angina pectoris: Assessment with a radionuclide approach

Abstract

Left ventricular function and size were assessed with equilibrium radionuclide angiography at rest and after administration of 0.6 mg of sublingual nitroglycerin in 12 patients with a history of previous myocardial infarction. Spontaneous angina developed in five patients and seven patients had no pain at the time of study. Sequential ejection fractions and end-diastolic and end-systolic volumes were developed by summing multiple R-R intervals to produce a composite time-activity curve. Volumes were calculated with a nongeometric method that utilizes counts at end-diastole and end-systole and is corrected for total heartbeats and plasma radioactivity. In the patients without acute ischemia, peak increase in ejection fraction occurred 6 to 8 minutes after ingestion of nitroglycerin and was associated with an equal decrease in end-diastolic and end-systolic volumes with no change in stroke volume. End-diastolic and end-systolic volumes, stroke volume, heart rate and systolic blood pressure all returned to baseline levels by 1 hour after nitroglycerin. In the patients with spontaneous angina, ejection fraction and stroke volume decreased before pain occurred. End-diastolic volume increased slightly (7 percent), but end-systolic volume increased markedly (38 percent), thus explaining the decrease in stroke volume. After nitroglycerin, end-diastolic volume and end-systolic volume and systolic blood pressure decreased and stroke volume and ejection fraction increased. Improvement in function occurred before relief of pain. It is concluded that the action of nitroglycerin on the left ventricle in patients without acute ischemia is to increase ejection fraction by an equal decrease in end-diastolic and end-systolic volumes with little change in stroke volume. A reduction in left ventricular function during acute ischemia precedes complaints of pain and is associated with an increase in end-systolic and end-diastolic volumes and a decrease in ejection fraction and stroke volume. In these patients, nitroglycerin appeared to contribute to relief of pain by decreasing end-diastolic volume and systolic blood pressure.