The effect of isosorbide dinitrate on left ventricular size, wall stress and left ventricular function in chronic refractory heart failure. An echocardiographic study

Joseph A.C. Gomes, Clarita R. Carambas, Harriette E. Moran, Malkiat S. Dhatt, Antonino H. Calon, Antonio R. Caracta, Anthony N. Damato

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

To determine the effect of a long-acting vasodilator isosorbide dinitrate (ID) on ventricular performance, 16 patients with refractory congestive heart failure underwent echocardiographic studies during control and for a period of 2 hours after the administration of 10 mg of sublingual ID. The effects of ID were seen in 5 to 10 minutes, reached maximum at 30 ± 3 minutes lasted for 60 minutes and dissipated thereafter. At the maximal drug effect, a significant decline in mean blood pressure (74 ± 2 versus 81 ± 3 mm Hg, p < 0.001), left ventricular afterload (228 × 103 ± 9 × 103 dynes/cm2 versus 273 × 103 ± 12 × 103 dynes/cm2 p < 0.001), end-diastolic dimension (5.90 ± 0.13 versus 6.40 ± 0.15 cm, p < 0.005) and end-systolic dimension (4.8 ± 0.15 versus 5.50 ± 0.17 cm, p < 0.001) occurred. These changes were associated with a significant increase in per cent fractional shortening (19 ± 2 per cent versus 14.5 ± 1.3 per cent, p < 0.001), mean rate of circumferential fiber shortening (VCF) (0.78 ± 0.06 versus 0.61 ± 0.05 circumferences per second (circ/sec) p < 0.001) and normalized mean posterior wall velocity (VPW) (0.65 ± 0.05 versus 0.47 ± 0.03 sec-1, p < 0.001) when heart rate was not significantly altered. All 16 patients were maintained on long-term ID therapy. Six of 16 patients (38 per cent) died within 17 to 270 days after the acute study. Nine of 16 patients have been followed for a period of three to 24 months and are clinically improved. These findings suggest that (1) ID reduces left ventricular size, preload and afterload, and improves ventricular performance; and (2) the use of ID might be of value as adjunctive therapy in acute/chronic management of refractory heart failure.

Original languageEnglish
Pages (from-to)794-802
Number of pages9
JournalAmerican Journal of Medicine
Volume65
Issue number5
DOIs
StatePublished - Nov 1978
Externally publishedYes

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