Improvement in wall motion after pindolol: a mechanism for the preservation of left ventricular function in coronary artery disease.
1. In order to evaluate the mechanism by which beta blockers with intrinsic sympathomimetic activity preserve left ventricular systolic function at rest, 46 patients with coronary artery disease were studied by right and left heart catheterization and left ventriculography. Patients were studied using a double-blind, randomized protocol before and after a single intravenous dose of 3 mg propranolol (N = 22) or 0.5 mg pindolol (N = 24). 2. Mean right atrial pressure increased similarly after both drugs. Mean pulmonary artery pressure, left ventricular end-diastolic pressure, mean aortic pressure, and peripheral vascular resistance did not change significantly after either drug. Cardiac index (before: 3.0 +/- 0.7 (mean +/- SEM); after: 2.8 +/- 0.2 1 min-1 m-2) and heart rate (before: 78 +/- 15; after: 72 +/- 12 bpm) decreased only after propranolol administration. 3. Ejection fraction decreased only after propranolol (48 +/- 16 to 41 +/- 15%). Improvement in segmental wall motion abnormalities was noted (23 of 47 segments) only after pindolol. The total left ventricular wall motion score improved after pindolol and worsened after propranolol (P less than 0.05). In patients with impaired left ventricular function, pindolol administration resulted in improved resting ejection fraction. 4. Thus, the acute hemodynamic consequences of pindolol administration differ from those of propranolol owing to the preservation of left ventricular systolic function which seems to be related to the intrinsic sympathomimetic effect of pindolol on areas of reversible wall motion abnormality.
Manfroi
W C
WC
Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brasil.
Vieira
S R
SR
Koppe
V F
VF
Goldin
J R
JR
Freitas
F M
FM
Faraco
E Z
EZ
Ribeiro
J P
JP
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001794:Blood Pressure / Q000187:drug effects; D006328:Cardiac Catheterization; D002986:Clinical Trials as Topic; D003327:Coronary Disease / Q000503:physiopathology*; D004311:Double-Blind Method; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000187:drug effects*; D010869:Pindolol / Q000494:pharmacology*; D011433:Propranolol / Q000494:pharmacology*; D011859:Radiography
D011433:Propranolol; D010869:Pindolol