The potential of
nitroglycerin for improving global and regional ventricular function after acute
myocardial infarction and predicting serial change in ventricular function at the time of hospital discharge was investigated. Equilibrium multiple gated blood pool scintigrams were performed at rest before and after
sublingual administration of
nitroglycerin in 18 patients an average of 36 hours after
infarction and again at discharge. Global right and left ventricular function and regional left ventricular function of
infarct and noninfarct zones were determined scintigraphically. In the early study
nitroglycerin increased both mean (+/- standard deviation) left ventricular ejection fraction (0.51 +/- 0.15 to 0.55 +/- 0.15 ; p less than 0.02) and mean right ventricular ejection fraction (0.42 +/- 0.14 to 0.47 +/- 0.13; p less than 0.05). Left ventricular ejection fraction significantly increased in 5 of the 18 patients. It increased late in five of the six patient who exhibited an increase early after
nitroglycerin but in only 2 of the 12 patients who did not exhibit an early increase (p less than 0.06). Regional ejection fraction in the
infarct zone increased late in 7 of the 12 patients who exhibited an early increase after
nitroglycerin and in none of the 6 who did not exhibit an early increase (p less than 0.05). Both right and left ventricular global ejection fraction and regional ejection fraction showed little late responsiveness to
nitroglycerin. Early after
infarction, sublingual
nitroglycerin improved left, right and regional ejection fraction at the
infarct site in some patients. These
nitroglycerin-induced changes predicted those patients whose global ventricular function and regional left ventricular function at the
infarct site improved late.