Left ventricular wall motion response to intravenous propranolol

Abstract

The effects of intravenous propranolol on left ventricular wall motion and hemodynamics were studied in 16 patients, 12 with significant coronary artery disease and four with chest pain but no coronary disease. Eight patients received 0.10 mg/kg and eight received 0.15 mg/kg of propranolol intravenously. All underwent atrial pacing at a constant rate. Left ventricular angiograms were performed before and 20 minutes after propranolol. At both doses, propranolol caused no significant change in left ventricular systolic or diastolic pressures, either before or immediately following ventriculography. Cardiac index fell significantly (3.4 plus or minus 0.2 [SEM] to 2.6 plus or minus 0.1 L/min/m-2) with the higher dose only. Of the ten patients with coronary artery disease and adequate ventriculograms, one patient had a normal left ventricle, two had regional hypokinesis, only three had areas of hypokinesis and akinesis, two had dyskinetic and akinetic areas, and two had areas of hypokinesis, akinesis and dyskinesis. No changes in regional contractility occurred with propranolol except for a minimal increase in hypokinesis in one patient at each dosage and equivocal development of a new area of slight hypokinesis in one patient and minimal apex of dyskinesis in another at the higher dosage. Of the four patients without coronary artery disease, two were affected by propranolol, one with initial regional akinesis and dyskinesis had slight worsening with propranolol and one with regional hypokinesis developed a definite new area of hypokinesis. Therefore, propranolol, even in large intravenous doses, resulted in no significant change in left ventricular wall motion in patients with coronary artery disease.