Impact of intravenous nitroglycerin on pulsed Doppler indexes of left ventricular filling in acute anterior myocardial infarction

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Abstract

Background

Restrictive transmitral Doppler flow patterns are associated with heart failure in acute myocardial infarction (AMI).

Methods and Results

The objective of this study was to evaluate the effect of intravenous nitroglycerin on the transmitral pulsed Doppler patterns in patients with anterior AMI. Twenty-four patients with anterior AMI were randomly assigned to receive incremental intravenous nitroglycerin or placebo over a 16-minute period with change to the other arm after a washout period. Left ventricular filling was assessed with transmitral pulsed Doppler echocardiography. According to the baseline E/A ratio, patients were divided into a restrictive group (n = 17, E/A ratio ≥1.4) and a nonrestrictive group (n = 7, E/A <1.4). In the restrictive group after administration of nitroglycerin the E/A ratio decreased (1.9 ± 0.7 to 1.1 ± 0.2, P < .001), E-wave peak velocity decreased (71 ± 10 to 60 ± 9 cm/s, P < .01), and A-wave peak velocity increased (39 ± 9 to 58 ± 8 cm/s, P < .01). In the nonrestrictive group there were no significant changes after nitroglycerin infusion in the E/A ratio (1.1 ± 0.2 to 0.8 ± 0.1, not significant), peak E-wave velocity (55 ± 4 to 47 ± 6 cm/s), and peak A-wave velocity (49 ± 8 to 52 ± 8 cm/s). Deceleration time increased significantly in both groups after administration of nitroglycerin. Placebo did not result in significant changes in hemodynamic or Doppler parameters in either group.

Conclusions

Intravenous nitroglycerin administration was associated with reversal of restrictive left ventricular diastolic filling pattern on pulsed wave Doppler in patients with anterior AMI.

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