Postural Changes and Isosorbide Dinitrate A Polygraphic Study in Patients with Coronary Artery Disease

Massimo ROMANO; Giuseppe FERRO; Massimo CHIARIELLO; Bruno RICCIARDELLI; Mario CONDORELLI

doi:10.1536/ihj.25.1011

Massimo ROMANO, Giuseppe FERRO, Massimo CHIARIELLO, Bruno RICCIARDELLI, Mario CONDORELLI

Author information

Keywords: Systolic time intervals, Diastolic time intervals, Nitrates, Ischemic heart disease

JOURNAL FREE ACCESS

1984 Volume 25 Issue 6 Pages 1011-1018

DOI https://doi.org/10.1536/ihj.25.1011

Details

Published: 1984 Received: March 08, 1983 Available on J-STAGE: December 09, 2008 Accepted: - Advance online publication: - Revised: -
Correction information
Date of correction: December 09, 2008 Reason for correction: - Correction: TITLE Details: Wrong : Postural Changes and Isosorbide Dinitrate
Right : Postural Changes and Isosorbide Dinitrate A Polygraphic Study in Patients with Coronary Artery Disease

Date of correction: December 09, 2008 Reason for correction: - Correction: SUBTITLE Details: Wrong : A Polygraphic Study in Patients with Coronary Artery Disease

Date of correction: December 09, 2008 Reason for correction: - Correction: ABSTRACT Details: Wrong : Sitting or orthostatic positions and trinitrine-like drugs reduce venous return. We focused on the non-invasive assessment of postural-induced cardiovascular stress and isosorbide dinitrate (IDN) induced changes in 8 male patients with coronary artery disease (CAD), using polygraphic recordings by means of a Thermistor Pulse Transducer.
The pre-ejection period (PEP) is sensitive to reduced preload and to the positive inotropic state of the myocardium. In addition, the % diastole (RR interval-electromechanical systole/RR in-terval) has been recently demonstrated to be correlated to coronary perfusion in CAD patients.
We observed that IDN in clinostatism and the sitting position reduced preload (longer PEP) with increased heart rate (HR) and did not affect % diastole. In orthostatism, while controls showed an increased HR and prolonged PEP, the HR was higher after IDN, with a fall in PEP and a significant decrease in % diastole.
We ascribed this change to adrenergic stimulation by the hypotensive actions of IDN (lowered mean blood pressure) in orthostatism and with a fall in coronary perfusion. Caution should be taken in CAD patients when postural stress could occur during IDN treatment. Moreover, polygraphic studies can be useful to detect individual responses to nitrates and serial recordings could be employed to assess late responses to chronic management with IDN.
Right : Sitting or orthostatic positions and trinitrine-like drugs reduce venous return. We focused on the non-invasive assessment of postural-induced cardiovascular stress and isosorbide dinitrate (IDN) induced changes in 8 male patients with coronary artery disease (CAD), using polygraphic recordings by means of a Thermistor Pulse Transducer.
The pre-ejection period (PEP) is sensitive to reduced preload and to the positive inotropic state of the myocardium. In addition, the % diastole (RR interval-electromechanical systole / RR interval) has been recently demonstrated to be correlated to coronary perfusion in CAD patients.
We observed that IDN in clinostatism and the sitting position reduced preload (longer PEP) with increased heart rate (HR) and did not affect % diastole. In orthostatism, while controls showed an increased HR and prolonged PEP, the HR was higher after IDN, with a fall in PEP and a significant decrease in % diastole.
We ascribed this change to adrenergic stimulation by the hypotensive actions of IDN (lowered mean blood pressure) in orthostatism and with a fall in coronary perfusion. Caution should be taken in CAD patients when postural stress could occur during IDN treatment. Moreover, polygraphic studies can be useful to detect individual responses to nitrates and serial recordings could be employed to assess late responses to chronic management with IDN.

Date of correction: December 09, 2008 Reason for correction: - Correction: AFFILIATION Details: Wrong :
1) Cattedra di Clinica Medica Generale e Terapia Medica I, II Facoltà di Medicina e Chirurgia

Right :
1) the Cattedra di Clinica Medica Generale e Terapia Medica I, II Facoltà di Medicina e Chirurgia

Date of correction: December 09, 2008 Reason for correction: - Correction: CITATION Details: Wrong : 1. Rushmer RF: Effects of posture. in Cardiovascular Dynamics, Chap 7, WB Saunders Co, Philadelphia, 1961
2. HirshIeifer I: A clinico-pharmacological comparison of the nitrites. Western Med 4: 263, 1963
3. Stafford RW, Harris WS, Weissler AM: Left ventricular systolic time intervals as indices of postural circulatory stress in man. Circulation 41: 485, 1970
4. Lange VD, Spodick DH: Postural effects on the noninvasive baseline of ventricular performance. Cardiology 62: 296, 1977
5. Lange VD, Spodick DH: Constant load vs rate targeted exercise: responses of systolic intervals. J Appl Physiol 38: 794, 1975
6. Gregg DE: Factors influencing coronary blood flow in the presence of coronary obstructive disease. in Atherosclerosis and Coronary Heart Disease, ed by Likoff W, Segal BL, Insull W Jr, Moyer JH, Grune and Stratton, New York and London, 1972
7. Romano M, Ferro G, Tari MG, Ricciardelli B, D'Ascia C, Chiariello M: Variazioni pos-turali e funzione ventricolare sinistra nel l'uomo. Interferenza dei farmaci vasodilatatori. Minerva Cardioang 30: 189, 1982
8. Ferro G, Chiariello M, Santinelli V, Tari MG, Condorelli M: Systolic time intervals measured by a thermistor pulse transducer: a new means for the evaluation of cardiac performance during exercise, in Systolic Time Intervals, ed by List WF, Gravenstein JS, Spodick DH, Springer-Verlag, Berlin-Heidelberg-New York, 1979
9. Lewis RP, Rittgers SE, Forester WF, Boudoulas H: A critical review of the systolic time intervals. Circulation 56: 146, 1977
10. Boudoulas H, Rittgers SE, Lewis RP, Leier CV, Weissler AM: Changes in diastolic time with various pharmacologic agents. Implication for myocardial perfusion. Circulation 60: 164, 1979
11. Snedecor GW, Cochran WG: Statistical Methods. Iowa University Press, 1967
12. Garrard CL Jr, Weissler AM, Dodge HT: The relationship of alterations in systolic time intervals to ejection fraction in patients with cardiac disease. Circulation 42: 455, 1970
13. Massie B, Kraumer B, Haughom F: Postural hypotension during hydralazine-isosorbide dinitrate therapy for chronic heart failure. Circulation 63: 658, 1981
14. Ferro G, Maione S, Tari MG, Perticone F, Giunta A, Chiariello M: Reliability of the PI index in the evaluation of cardiac failure. 12th European Congress for Non-invasive Cardiovascular Dynamics, Athens, 1980, Excerpta Medica (in press)

Right : 1. Rushmer RF: Effects of posture. in Cardiovascular Dynamics, Chap 7, WB Saunders Co, Philadelphia, 1961
2. Hirshleifer I: A clinico-pharmacological comparison of the nitrites. Western Med 4: 263, 1963
3. Stafford RW, Harris WS, Weissler AM: Left ventricular systolic time intervals as indices of postural circulatory stress in man. Circulation 41: 485, 1970
4. Lange VD, Spodick DH: Postural effects on the noninvasive baseline of ventricular performance. Cardiology 62: 296, 1977
5. Lange VD, Spodick DH: Constant load vs rate targeted exercise: responses of systolic intervals. J Appl Physiol 38: 794, 1975
6. Gregg DE: Factors influencing coronary blood flow in the presence of coronary obstructive disease. in Atherosclerosis and Coronary Heart Disease, ed by Likoff W, Segal BL, Insull W Jr, Moyer JH, Grune and Stratton, New York and London, 1972
7. Romano M, Ferro G, Tari MG, Ricciardelli B, D'Ascia C, Chiariello M: Variazioni posturali e funzione ventricolare sinistra nel l'uomo. Interferenza dei farmaci vasodilatatori. Minerva Cardioang 30: 189, 1982
8. Ferro G, Chiariello M, Santinelli V, Tari MG, Condorelli M: Systolic time intervals measured by a thermistor pulse transducer: a new means for the evaluation of cardiac performance during exercise, in Systolic Time Intervals, ed by List WF, Gravenstein JS, Spodick DH, Springer-Verlag, Berlin-Heidelberg-New York, 1979
9. Lewis RP, Rittgers SE, Forester WF, Boudoulas H: A critical review of the systolic time intervals. Circulation 56: 146, 1977
10. Boudoulas H, Rittgers SE, Lewis RP, Leier CV, Weissler AM: Changes in diastolic time with various pharmacologic agents. Implication for myocardial perfusion. Circulation 60: 164, 1979
11. Snedecor GW, Cochran WG: Statistical Methods. Iowa University Press, 1967
12. Garrard CL Jr, Weissler AM, Dodge HT: The relationship of alterations in systolic time intervals to ejection fraction in patients with cardiac disease. Circulation 42: 455, 1970
13. Massie B, Kraumer B, Haughom F: Postural hypotension during hydralazine-isosorbide dinitrate therapy for chronic heart failure. Circulation 63: 658, 1981
14. Ferro G, Maione S, Tari MG, Perticone F, Giunta A, Chiariello M: Reliability of the PI index in the evaluation of cardiac failure. 12th European Congress for Non-invasive Cardiovascular Dynamics, Athens, 1980, Excerpta Medica (in press)

Date of correction: December 09, 2008 Reason for correction: - Correction: PDF FILE Details: -

Abstract

Sitting or orthostatic positions and trinitrine-like drugs reduce venous return. We focused on the non-invasive assessment of postural-induced cardiovascular stress and isosorbide dinitrate (IDN) induced changes in 8 male patients with coronary artery disease (CAD), using polygraphic recordings by means of a Thermistor Pulse Transducer.
The pre-ejection period (PEP) is sensitive to reduced preload and to the positive inotropic state of the myocardium. In addition, the % diastole (RR interval-electromechanical systole / RR interval) has been recently demonstrated to be correlated to coronary perfusion in CAD patients.
We observed that IDN in clinostatism and the sitting position reduced preload (longer PEP) with increased heart rate (HR) and did not affect % diastole. In orthostatism, while controls showed an increased HR and prolonged PEP, the HR was higher after IDN, with a fall in PEP and a significant decrease in % diastole.
We ascribed this change to adrenergic stimulation by the hypotensive actions of IDN (lowered mean blood pressure) in orthostatism and with a fall in coronary perfusion. Caution should be taken in CAD patients when postural stress could occur during IDN treatment. Moreover, polygraphic studies can be useful to detect individual responses to nitrates and serial recordings could be employed to assess late responses to chronic management with IDN.

Corresponding author

Correction information

Register with J-STAGE for free!