Effect of propranolol on myocardial perfusion images and exercise ejection fraction in men with coronary artery disease.

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Abstract
Propranolol increases exercise performance is association with a decrease in exercise heart rate and blood pressure. In 30 men with coronary disease and exercise limited by angina, 15 without prior infarction and 15 with infarction, left ventricular ejection fraction (LVEF) (scintillation probe) at rest and during supine bicycle exercise and myocardial blood flow distribution (MBF) (201Tl imaging) during treadmill exercise were measured. Exercise was performed as control and after 1 wk of treatment with propranolol (40 mg orally 4 times daily). Propranolol improved exercise LVEF (at the same work load) (men without infarction: control 0.37 .+-. 0.02, average .+-. SEM [standard error of the mean]; propranolol 0.45 .+-. 0.01; n = 15, P < 0.01; and with infarction: control 0.30 .+-. 0.01, propranolol 0.36 .+-. 0.01; n = 15, P < 0.05). Propranolol also improved MBF during exercise to the same work load in men without infarction (comparison of integrated normalized count-rate differences, 607 normalized counts). In men with infarction, propranolol did not alter MBF (15 normalized counts). Placebo did not alter normalized counts by more than .+-. 150. Changes in exercise LVEF and MBF were related. MBF improved in 17 men with propranolol treatment and LVEF was increased in 15. Of 6 men who had no change in MBF, exercise LVEF increased in 3 and did not change in 3. Propranolol was associated with a worsening of MBF in 5 men and all had no change in exercise LVEF. Apparently, propranolol favorably alters MBF and LVEF in men with coronary disease, particularly in men without prior myocardial infarction.