Improvement in left ventricular wall motion following nitroglycerin

Coronary artery disease patients frequently have left ventricular wall motion abnormalities. Though nitroglycerin is commonly used in ischemic heart disease, its effects on wall motion abnormalities is unknown. In this study, the effects of nitroglycerin on wall motion abnormalities and on ejection fraction in 25 patients were evaluated. 16 had coronary artery disease (> 70% luminal narrowing). Six had no evidence of heart disease and three had congestive cardiomyopathies with normal coronary arteries. Left ventricular angiography was performed prior to and 6 min after administration of 0.4 mg of sublingual nitroglycerin. 12 of the 16 coronary artery disease patients had wall motion abnormalities, and in seven of these, segmental wall motion improved after nitroglycerin administration. In five, wall motion did not change. The initial heart rate, left ventricular systolic and end diastolic pressure, and left ventricular end diastolic volumes were not different for those whose wall motion improved, versus those whose did not. The increase in the former and fall in the latter three hemodynamic parameters were significant (p < 0.01), and similar for the two groups. In those whose wall motion abnormalities improved after nitroglycerin, ejection fraction (mean ± SE) increased significantly (p < 0.05), from 0.47 ± 0.025 to 0.62 ± 0.046. In those without improvement, the ejection fraction went from 0.55 ± 0.056 to 0.58 ± 0.051 (NS). Three patients with congestive cardiomyopathy showed no improvement in ventricular wall motion or ejection fraction after nitroglycerin administration. Left ventricular wall motion abnormalities and ejection fraction improved in some coronary artery disease patients following nitroglycerin administration. The mechanism for this is unknown; however, ventriculography before and after nitroglycerin may be of potential usefulness for identifying areas of reversible wall motion abnormalities.