Effect of sublingual nitroglycerin on cardiac performance in patients with coronary artery disease and non-dyskinetic left ventricular contraction.

In 8 patients with coronary artery disease and symmetrical left ventricular contraction, an echocardiographic study of left ventricular function was performed before and 3 minutes after the administration of 0-6 mg nitroglycerin sublingually. The left ventricular end-diastolic diameter decreased from 5-2 +/- 0-2 to 4-9 +/- 0-2 cm (P less than 0-05) and the end-systolic diameter from 4-2 +/- 0-2 to 3-7 +/- 0-2 cm (P less than 0-001). The estimated stroke volume did not change significantly, while the cardiac output increased, 5-8 +/- 0-6 to 7-7 +/- 0-6 l min-1 (P less than 0-001) and the heart rate increased from 72 +/- 5 to 90 +/- 6 (P less than 0-001). The mean arterial blood pressure decreased from 105 +/- 4 to 88 +/- 3 mmHg (P less than 0-001). The ejection fraction increased from 53 +/- 3 per cent to 65 +/- 6 per cent (P less than 0-001) and the mean velocity of circumferential fibre shortening (VCF) from 0-81 +/- 0-05 to 1-15 +/- 0-10 circumferences per second (P less than 0-001). The estimated midsystolic midwall stress decreased from 155 +/- 14 g cm-2 to 102 +/- 12 g cm-2 after mitroglycerin (P less than 0-001). The administration of nitroglycerin was associated with a significant decrease in left ventricular preload and afterload. A vasodilating effect is suggested by the fall in peripheral resistance. The overall improvement in ejection fraction and VCF may not reflect a true increase contractility, because of the concomitant fall in wall stress.