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Response of the left ventricle to nitroglycerin in patients with and without mitral regurgitation.

Left ventricular cineangiographic volumes and haemodynamics were measured before and after nitroglycerin in I7 patients. The average end-diastolic volume was reduced by nitroglycerinfrom 82 to 69 ml/M2 (P< o.ooI) in 8 patients without mitral regurgitation andfrom I59 to ii6 ml/m2 (P< o.oos) in 9 patients with mitral regurgitation. The haemodynamic response, however, differed in the two circumstances. Whereas nitroglycerin increased the average ejectionfractionfrom os53 to o 64 (P< o oi) in the patients without mitral regurgitation, the ejection fraction was decreased by the drug from o-6s to o 52 (P< o oos) in the mitral regurgitation patients. However, the forward cardiac output was not changed by nitroglycerin; the reduction in ejection fraction in the patients with mitral regurgitation must therefore have been due to a reduction in backflow into the left atrium. This indicates that nitroglycerin reduced the severity of mitral regurgitation in association with (and probably as a result of) a reduction in heart size. Mean circumferentialfibre shortening rate was reduced (P< o os) by nitroglycerin in 5 of the patients with mitral regurgitation who also had coronary artery disease but notfor this group of patients as a whole, norfor the group without mitral regurgitation (all with coronary artery disease). Average left ventricular enddiastolic pressure was reduced by nitroglycerin in the patients without mitral regurgitation (P< o.oi) but not in the patients with mitral regurgitation.