Nitroglycerin enhances the ability of dobutamine stress echocardiography to detect hibernating myocardium

Lijie Ma, Lianglong Chen, Linda Gillam, David D. Waters, Chunguang Chen

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background: A biphasic response of wall thickening with initial improvement and subsequent deterioration during dobutamine stress echocardiography (DSE) has been increasingly used for detection of hibernating myocardium. However, the improvement of wall thickening at low- dose DSE may be limited in hibernating myocardium by severe hypoperfusion. Nitroglycerin (NTG) improves myocardial perfusion, reduces oxygen demand, and may enhance low-dose dobutamine to improve wall thickening. Methods and Results: A pig model of myocardial hibernation of 24 hours to 7 days was created through severe left anterior descending coronary artery stenosis with coronary flow reductions of ≃40%, producing severe regional left ventricular dysfunction but no infarction in seven pigs. Myocardial infarction was produced in five pigs with occlusion of the artery. DSE was performed with incremental doses with and without an NTG infusion of 50 to 100 μg/min. In the hibernating group, NTG alone improved wall thickening in the hibernating region modestly from 11.4±7.2% at baseline to 19.1±7.0%. The improvement was associated with increased regional coronary flow from 0.46±0.12 to 0.55±0.13 mL · beat-1 · 100 g myocardium-1 (P<.05). There was an additive effect of NTG to low-dose (2.5 to 5 μg · kg-1 · min-1) dobutamine on wall thickening in the hibernating region. The improvement of wall thickening of hibernating myocardium with NTG and dobutamine, from 23.7±11.1% to 31.1±8.9% (P<.001), was associated with an increase in regional coronary flow (P<.01). NTG did not prevent high doses of dobutamine from inducing deterioration of wall thickening in hibernating myocardium. In the infarcted group, no improvement in wall thickening was observed in infarcted regions during NTG infusion, dobutamine infusion, or the combination. Conclusions: NTG enhances the improvement of wall thickening at low-dose dobutamine and does not prevent high-dose dobutamine from inducing ischemia in hibernating myocardium. Thus, NTG augments the biphasic response of wall thickening and improves the accuracy of DSE for detecting viable myocardium.

Original languageEnglish (US)
Pages (from-to)3992-4001
Number of pages10
JournalCirculation
Volume96
Issue number11
DOIs
StatePublished - Jan 1 1997

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Stress Echocardiography
Nitroglycerin
Dobutamine
Myocardium
Swine
Myocardial Stunning
Coronary Stenosis
Left Ventricular Dysfunction
Infarction
Ischemia
Arteries
Perfusion
Myocardial Infarction
Oxygen

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Ma, Lijie ; Chen, Lianglong ; Gillam, Linda ; Waters, David D. ; Chen, Chunguang. / Nitroglycerin enhances the ability of dobutamine stress echocardiography to detect hibernating myocardium. In: Circulation. 1997 ; Vol. 96, No. 11. pp. 3992-4001.
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abstract = "Background: A biphasic response of wall thickening with initial improvement and subsequent deterioration during dobutamine stress echocardiography (DSE) has been increasingly used for detection of hibernating myocardium. However, the improvement of wall thickening at low- dose DSE may be limited in hibernating myocardium by severe hypoperfusion. Nitroglycerin (NTG) improves myocardial perfusion, reduces oxygen demand, and may enhance low-dose dobutamine to improve wall thickening. Methods and Results: A pig model of myocardial hibernation of 24 hours to 7 days was created through severe left anterior descending coronary artery stenosis with coronary flow reductions of ≃40{\%}, producing severe regional left ventricular dysfunction but no infarction in seven pigs. Myocardial infarction was produced in five pigs with occlusion of the artery. DSE was performed with incremental doses with and without an NTG infusion of 50 to 100 μg/min. In the hibernating group, NTG alone improved wall thickening in the hibernating region modestly from 11.4±7.2{\%} at baseline to 19.1±7.0{\%}. The improvement was associated with increased regional coronary flow from 0.46±0.12 to 0.55±0.13 mL · beat-1 · 100 g myocardium-1 (P<.05). There was an additive effect of NTG to low-dose (2.5 to 5 μg · kg-1 · min-1) dobutamine on wall thickening in the hibernating region. The improvement of wall thickening of hibernating myocardium with NTG and dobutamine, from 23.7±11.1{\%} to 31.1±8.9{\%} (P<.001), was associated with an increase in regional coronary flow (P<.01). NTG did not prevent high doses of dobutamine from inducing deterioration of wall thickening in hibernating myocardium. In the infarcted group, no improvement in wall thickening was observed in infarcted regions during NTG infusion, dobutamine infusion, or the combination. Conclusions: NTG enhances the improvement of wall thickening at low-dose dobutamine and does not prevent high-dose dobutamine from inducing ischemia in hibernating myocardium. Thus, NTG augments the biphasic response of wall thickening and improves the accuracy of DSE for detecting viable myocardium.",
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Nitroglycerin enhances the ability of dobutamine stress echocardiography to detect hibernating myocardium. / Ma, Lijie; Chen, Lianglong; Gillam, Linda; Waters, David D.; Chen, Chunguang.

In: Circulation, Vol. 96, No. 11, 01.01.1997, p. 3992-4001.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Nitroglycerin enhances the ability of dobutamine stress echocardiography to detect hibernating myocardium

AU - Ma, Lijie

AU - Chen, Lianglong

AU - Gillam, Linda

AU - Waters, David D.

AU - Chen, Chunguang

PY - 1997/1/1

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N2 - Background: A biphasic response of wall thickening with initial improvement and subsequent deterioration during dobutamine stress echocardiography (DSE) has been increasingly used for detection of hibernating myocardium. However, the improvement of wall thickening at low- dose DSE may be limited in hibernating myocardium by severe hypoperfusion. Nitroglycerin (NTG) improves myocardial perfusion, reduces oxygen demand, and may enhance low-dose dobutamine to improve wall thickening. Methods and Results: A pig model of myocardial hibernation of 24 hours to 7 days was created through severe left anterior descending coronary artery stenosis with coronary flow reductions of ≃40%, producing severe regional left ventricular dysfunction but no infarction in seven pigs. Myocardial infarction was produced in five pigs with occlusion of the artery. DSE was performed with incremental doses with and without an NTG infusion of 50 to 100 μg/min. In the hibernating group, NTG alone improved wall thickening in the hibernating region modestly from 11.4±7.2% at baseline to 19.1±7.0%. The improvement was associated with increased regional coronary flow from 0.46±0.12 to 0.55±0.13 mL · beat-1 · 100 g myocardium-1 (P<.05). There was an additive effect of NTG to low-dose (2.5 to 5 μg · kg-1 · min-1) dobutamine on wall thickening in the hibernating region. The improvement of wall thickening of hibernating myocardium with NTG and dobutamine, from 23.7±11.1% to 31.1±8.9% (P<.001), was associated with an increase in regional coronary flow (P<.01). NTG did not prevent high doses of dobutamine from inducing deterioration of wall thickening in hibernating myocardium. In the infarcted group, no improvement in wall thickening was observed in infarcted regions during NTG infusion, dobutamine infusion, or the combination. Conclusions: NTG enhances the improvement of wall thickening at low-dose dobutamine and does not prevent high-dose dobutamine from inducing ischemia in hibernating myocardium. Thus, NTG augments the biphasic response of wall thickening and improves the accuracy of DSE for detecting viable myocardium.

AB - Background: A biphasic response of wall thickening with initial improvement and subsequent deterioration during dobutamine stress echocardiography (DSE) has been increasingly used for detection of hibernating myocardium. However, the improvement of wall thickening at low- dose DSE may be limited in hibernating myocardium by severe hypoperfusion. Nitroglycerin (NTG) improves myocardial perfusion, reduces oxygen demand, and may enhance low-dose dobutamine to improve wall thickening. Methods and Results: A pig model of myocardial hibernation of 24 hours to 7 days was created through severe left anterior descending coronary artery stenosis with coronary flow reductions of ≃40%, producing severe regional left ventricular dysfunction but no infarction in seven pigs. Myocardial infarction was produced in five pigs with occlusion of the artery. DSE was performed with incremental doses with and without an NTG infusion of 50 to 100 μg/min. In the hibernating group, NTG alone improved wall thickening in the hibernating region modestly from 11.4±7.2% at baseline to 19.1±7.0%. The improvement was associated with increased regional coronary flow from 0.46±0.12 to 0.55±0.13 mL · beat-1 · 100 g myocardium-1 (P<.05). There was an additive effect of NTG to low-dose (2.5 to 5 μg · kg-1 · min-1) dobutamine on wall thickening in the hibernating region. The improvement of wall thickening of hibernating myocardium with NTG and dobutamine, from 23.7±11.1% to 31.1±8.9% (P<.001), was associated with an increase in regional coronary flow (P<.01). NTG did not prevent high doses of dobutamine from inducing deterioration of wall thickening in hibernating myocardium. In the infarcted group, no improvement in wall thickening was observed in infarcted regions during NTG infusion, dobutamine infusion, or the combination. Conclusions: NTG enhances the improvement of wall thickening at low-dose dobutamine and does not prevent high-dose dobutamine from inducing ischemia in hibernating myocardium. Thus, NTG augments the biphasic response of wall thickening and improves the accuracy of DSE for detecting viable myocardium.

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