The acute effects of low flow oxygen and isosorbide dinitrate on left and right ventricular ejection fractions in chronic obstructive pulmonary disease.
The objectives of this study were to determine the effects of low flow oxygen and isosorbide dinitrate on rest and exercise biventricular ejection fractions in patients with chronic obstructive pulmonary disease and to relate these ejection fraction responses to changes in pressure and flow. Nine patients with stable, moderate to severe chronic obstructive pulmonary disease who had no prior history of heart failure performed supine exercise with simultaneous hemodynamic and radionuclide ventriculographic monitoring. Eight patients performed a second exercise during low flow oxygen breathing and five performed a third exercise after ingesting 10 mg oral isosorbide. Oxygen led to a decrease in exercise pulmonary artery pressure in all subjects and a decline in total pulmonary resistance in five of the seven in whom it was measured. Right ventricular ejection fraction increased 0.05 or more only in subjects who had a decrease in total pulmonary resistance. Isosorbide fed to an increase in rest and exercise right and left ventricular ejection fractions with simultaneous decreases in pulmonary artery pressure, total pulmonary resistance, blood pressure and arterial oxygen tension. These results suggest that in patients with chronic obstructive pulmonary disease but without a history of right heart failure, the right ventricular systolic functional response to low flow oxygen and isosorbide at rest and exercise is, in part, determined by changes in total pulmonary resistance. The chronic relation between right ventricular ejection fraction and pulmonary hemodynamics in patients with chronic obstructive pulmonary disease remains to be evaluated.
D001794:Blood Pressure; D002302:Cardiac Output; D004912:Erythrocytes; D006321:Heart / Q000000981:diagnostic imaging; D006801:Humans; D007548:Isosorbide Dinitrate / Q000627:therapeutic use*; D008173:Lung Diseases, Obstructive / Q000503:physiopathology / Q000628:therapy*; D008875:Middle Aged; D010102:Oxygen Inhalation Therapy; D005082:Physical Exertion; D011651:Pulmonary Artery / Q000502:physiology; D011877:Radionuclide Imaging; D013318:Stroke Volume; D013667:Technetium; D014655:Vascular Resistance
D013667:Technetium; D007548:Isosorbide Dinitrate