Kingma I, Smiseth O A, Belenkie I, Knudtson M L, MacDonald R P, Tyberg J V, Smith E R
Am J Cardiol. 1986 Mar 1;57(8):673-7. doi: 10.1016/0002-9149(86)90857-x.
Nitroglycerin has been shown to cause a downward shift in the left ventricular (LV) pressure-volume relation in patients. To test the hypothesis that this shift is mediated by an alteration in pericardial pressure, 13 patients undergoing diagnostic cardiac catheterization were studied. LV and right ventricular (RV) pressure (micromanometers) and LV diameter (2-dimensional echocardiography) were measured simultaneously before and after sublingual administration of 0.3 to 0.6 mg of nitroglycerin. In the 11 patients with hemodynamic effects from nitroglycerin, mean LV end-diastolic pressure decreased from 12.7 +/- 5 mm Hg (mean +/- standard deviation) to 7.3 +/- 3 mm Hg (p less than 0.002) and mean RV end-diastolic pressure declined from 7.7 +/- 3 mm Hg to 5.0 +/- 1 mm Hg (p less than 0.001). However, nitroglycerin caused only a slight (6%) reduction in LV minor axis diameter, from 52 +/- 8 mm to 49 +/- 9 mm (p less than 0.05). Diastolic pressure-diameter plots constructed from early and late diastolic measurements demonstrated a downward shift in the relation. However, when RV end-diastolic pressure was used as an estimate of pericardial pressure (a procedure validated by studies in our laboratory), the transmural pressure-diameter points before and after administration of nitroglycerin defined a single curve. These observations are in keeping with the conclusions that nitroglycerin did not alter the elastic properties of the myocardium and that the decrease in LV end-diastolic pressure induced by nitroglycerin was primarily attributable to a reduction in external constraint.
在患者中，硝酸甘油已被证明会使左心室（LV）压力-容积关系向下移位。为了验证这种移位是由心包压力改变介导的这一假设，对13例接受诊断性心导管检查的患者进行了研究。在舌下给予0.3至0.6毫克硝酸甘油之前和之后，同时测量左心室和右心室（RV）压力（微测压计）以及左心室直径（二维超声心动图）。在11例对硝酸甘油有血流动力学效应的患者中，平均左心室舒张末期压力从12.7±5毫米汞柱（平均值±标准差）降至7.3±3毫米汞柱（p<0.002），平均右心室舒张末期压力从7.7±3毫米汞柱降至5.0±1毫米汞柱（p<0.001）。然而，硝酸甘油仅使左心室短轴直径略有（6%）减小，从52±8毫米降至49±9毫米（p<0.05）。根据舒张早期和晚期测量构建的舒张压-直径图显示该关系向下移位。然而，当使用右心室舒张末期压力作为心包压力的估计值时（这一程序已在我们实验室的研究中得到验证），给予硝酸甘油前后的跨壁压力-直径点定义了一条单一曲线。这些观察结果与以下结论一致，即硝酸甘油并未改变心肌的弹性特性，并且硝酸甘油引起的左心室舒张末期压力降低主要归因于外部约束的减少。
