Background: Restrictive transmitral Doppler flow patterns are associated with heart failure in acute myocardial infarction (AMI).
Methods and results: The objective of this study was to evaluate the effect of intravenous nitroglycerin on the transmitral pulsed Doppler patterns in patients with anterior AMI. Twenty-four patients with anterior AMI were randomly assigned to receive incremental intravenous nitroglycerin or placebo over a 16-minute period with change to the other arm after a washout period. Left ventricular filling was assessed with transmitral pulsed Doppler echocardiography. According to the baseline E/A ratio, patients were divided into a restrictive group (n = 17, E/A ratio > or =21.4) and a nonrestrictive group (n = 7, E/A <1.4). In the restrictive group after administration of nitroglycerin the E/A ratio decreased (1.9+/-0.7 to 1.1+/-0.2, P < .001), E-wave peak velocity decreased (71+/-10 to 60+/-9 cm/s, P < .01), and A-wave peak velocity increased (39+/-9 to 58+/-8 cm/s, P < .01 ). In the nonrestrictive group there were no significant changes after nitroglycerin infusion in the E/A ratio (1.1+/-0.2 to 0.8+/-0.1, not significant), peak E-wave velocity (55+/-4 to 47+/-6 cm/s), and peak A-wave velocity (49+/-8 to 52+/-8 cm/s). Deceleration time increased significantly in both groups after administration of nitroglycerin. Placebo did not result in significant changes in hemodynamic or Doppler parameters in either group.
Conclusions: Intravenous nitroglycerin administration was associated with reversal of restrictive left ventricular diastolic filling pattern on pulsed wave Doppler in patients with anterior AMI.