Effect of glyceryl trinitrate on peripheral arteries alters left ventricular hydraulic load in man

Toshio Yaginuma*, Alberto Avolio, Michael O'rourke, Wilmer Nichols, John J. Morgan, Paul Roy, David Baron, John Branson, Michael Feneley

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

175 Citations (Scopus)

Abstract

Summary: Effects of sublingual glyceryl trinitrate (GTN) were studied in ten patients without heart failure during diagnostic cardiac catheterisation following angiography. GTN caused substantial reduction in peak left ventricular and aortic pressure (19 mmHg) with lesser reduction in mean aortic pressure (9 mmHg) and no change in diastolic aortic pressure. Reduction in stroke volume (by 15%), associated with fall in left ventricular end diastolic pressure (by 4 mmHg) was insufficient to explain the marked (17 mmHg - 34%) reduction in pulse pressure. Decrease in pulse pressure was associated with loss of the late systolic peak on both the aortic and left ventricular pressure wave. This peak is caused by pulse wave reflection. GTN caused no change in peripheral resistance or in indices of aortic compliance (characteristic impedance, total arterial compliance) but was associated with reduction in fluctuations of both modulus and phase of aortic impedance. All these changes in pressure waves and in impedance spectra are explicable on the basis of decreased peripheral wave reflection. This can be attributed to the known vasodilatory effect of GTN on the peripheral arteries. Simulation of arterial vasodilatation in a multi-branched model of the systemic arterial system confirmed this interpretation. Dilatation of peripheral arteries explains in part the beneficial effects of GTN in adult man.

Original languageEnglish
Pages (from-to)153-160
Number of pages8
JournalCardiovascular Research
Volume20
Issue number2
DOIs
Publication statusPublished - Feb 1986
Externally publishedYes

Keywords

  • Aortic impedance
  • Glyceryl trinitrate
  • Systolic pressure
  • Ventricular afterload
  • Wave reflection

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