Effects of Nitroglycerin on Left Ventricular Wall Motion in Coronary Artery Disease

The effects of sublingual nitroglycerin (GTN) on left ventricular wall motion (LVWM) were examined by angiographic assessment in eight patients with anginal chest pain. Five of seven patients having occlusive coronary artery disease showed segmental abnormalities in LVWM characterized by regional hypokinesis or akinesis at rest. These abnormalities were accentuated by tachycardia induced by atrial pacing and were associated with the development of anginal chest pain. Two patients with one vessel coronary artery disease had normal LVWM at rest, but developed abnormalities during the stress of tachypacing. Administration of GTN reversed the LVWM abnormalities in all patients despite continued tachypacing. One patient with atypical chest pain but normal coronary arteries had normal LVWM at rest, following tachypacing, and after GTN. It is concluded that angiographic evaluation of LVWM provides a useful measure of segmental myocardial ischemia in patients with suspected coronary artery disease, and permits objective assessment of effects of antianginal drugs in reversing myocardial ischemia.