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Effects of Beta-Adrenergic Blockade in Acute Myocardial Infarction: Evaluation by Radionuclide Ventriculography

Departments of Medicine and Radiology, Vanderbilt University School of Medicine, Nashville, Tennessee

Correspondence: For reprints contact: Marvin W. Kronenberg, MD, Division of Cardiology, Vanderbilt University, Medical Center North, Nashville, TN 37232.

ABSTRACT

In acute myocardial infarction, beta-adrenergic blockade might depress left ventricular contractility or improve contractility by reducing ischemia. Gated equilibrium radio-nuclide ventriculography and cuff blood pressure were employed in 10 patients to assess the left ventricular systolic pressure/volume (P/V) ratio as an index of contractility before and after intravenous metoprolol 9.3 ± 2.5 hr after onset of infarction. In 13 normal subjects, the baseline left ventricular PV ratio was 3.5 and the left ventricular ejection fraction (LVEF) was 70%, both greater than the patients with infarction. In the patients after blockade, the systolic blood pressure decreased (p = 0.02), and the left ventricular end-systolic volume increased (p = 0.003), thus decreasing the P/V ratio from 1.7 to 1.4 (p = 0.003), while the ejection fraction (EF) was unchanged (55% versus 52%). The right ventricular ejection fraction (RVEF) decreased from 50% to 43% (p = 0.004). Thus, radionuclide ventriculography demonstrated that left ventricular contractility was reduced in patients with acute myocardial infarction and that beta-adrenergic blockade further decreased left ventricular contractility and right ventricular performance.

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