IMPACT OF INTRAVENOUS NITROGLYCERIN ON PULSED DOPPLER INDEXES OF LEFT-VENTRICULAR FILLING IN ACUTE ANTERIOR MYOCARDIAL-INFARCTION

Background Restrictive transmitral Doppler flow patterns are associate d with heart failure in acute myocardial infarction (AMI). Methods and Results The objective of this study was to evaluate the effect of int ravenous nitroglycerin on the transmitral pulsed Doppler patterns in p atients 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 gre ater than or equal to 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 pea k 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 nitroglyc erin infusion in the E/A ratio (1.1 +/- 0.2 to 0.8 +/- 0.1, not signif icant), peak E-wave velocity (55 +/- 4 to 47 +/- 6 cm/s), and peak A-w ave velocity (49 +/- 8 to 52 +/- 8 cm/s). Deceleration time increased significantly in both groups after administration of nitroglycerin. Pl acebo did not result in significant changes in hemodynamic or Doppler parameters in either group. Conclusions Intravenous nitroglycerin admi nistration was associated with reversal of restrictive left ventricula r diastolic filling pattern on pulsed wave Doppler in patients with an terior AMI.