What does this research mean for the field?

Dynamic echoventriculography is a valid noninvasive method for precisely evaluating cardiac function, accurately capturing changes in preload, afterload, and contractility induced by cardiovascular drugs. Novelty: ClaimNovelty.METHODOLOGICAL. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

January 1, 1978Open Access

Dynamic Echoventriculography Noninvasive Assessment of Effects of Nitroglycerin, Phenylephrine, Isoproterenol, and Propranolol on the Human Cardiovascular System

YHYuzo HirotaOsaka Medical and Pharmaceutical University MSMichihiro SuwaDokkyo Medical University KHKenjiro HoriOsaka Medical and Pharmaceutical University

Structured PICO

Does sequential administration of vasoactive and inotropic drugs allow noninvasive assessment of cardiac function parameters using echocardiography in healthy volunteers?

Population

12 healthy volunteers (6 males, 6 females), aged 16 to 37 years, without subclinical heart disease.

Intervention

Sequential administration of nitroglycerin (0.3 mg sublingual), phenylephrine (50 µg/min IV drip), isoproterenol (0.75 to 1.0 µg/min IV drip), and propranolol (4 mg IV over 1 min).

Comparator

Baseline (control state) prior to each pharmacological intervention.

Outcome

Changes in echocardiographic parameters of cardiac function (including EDVI, ESVI, SI, CI, EF, mean Vcf, STRESS, and LVMWI) measured 4 to 8 minutes after drug administration.surrogate

Dynamic echoventriculography using sequential pharmacological interventions can noninvasively and precisely assess the major determinants of cardiac performance (preload, afterload, and contractility).

Abstract

Effects of nitroglycerin, phenylephrine, isoproterenol, and propranolol on the cardiovascular system were studied sequentially using echocardiography to evaluate a method for a more precise assessment of cardiac function.Nitroglycerin reduced systolic blood pressere (sBP, 3.9%, p<0.01), enddiastolic (EDVI, 11.3%, p<0.001), end-systolic volume indices (ESVI, 10.0%, p<0.05), stroke index (SI, 13.1%, p<0.005), and cardiac index (CI, 7.1%, p<0.05) without changes in diastolic pressure (dBP), mean velocity of circumferential fiber shortening (mean Vcf), or ejection fraction (EF). Mid-systolic left ventricular (LV) endocardial stress (STRESS) as an index of afterload decreased by 13.6% (p<0.02).Afterload augmentation by phenylephrine infusion resulted in bradycardia, reductions of CI (9.6%, p<0.05) and mean Vcf (11.2%, p<0.001) without changes in ER.Tachycardia, reductions of EDVI (13.5%, p<0.05), ESVI (46.8%, p<0.00I), and STRESS (20.3%, p<0.005), and augmentations of CI (29.1%, p<0.001), mean Vcf (62.4%, p<0.001), and EF (16.2%, p<0.001) were induced by isoproterenol administration.Whereas no significant changes were observed in mean Vcf, EF, or other parameters of cardiac performance, decrease in LV minute work index (12.9%, p<0.05) with equivalent EDVI suggested minimal depression of LV function with intravenous injection of propranolol.These hemodynamic changes are in good agreement with the results obtained by animal experiments and invasive investigations. Indices of the 4 major determinants of cardiac performance, preload as enddiastolic dimension or EDVI, afterload as STRESS, contractility as EF or mean Vcf, and heart rate can all be assessed by this noninvasive method. The proposed method of sequential assessment of these parameters, changing preload, afterload, and contractility, i.e., dynamic echoventriculography should be a useful tool for the precise evaluation of cardiac function.

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