Effects of L-arginine on lower limb vasodilator reserve and exercise capacity in patients with chronic heart failure

Abstract

Objective-To determine whether the reactive hyperaemic response of the lower limb increases with improved exercise capacity after acute supplementation with L-arginine, the precursor of nitric oxide, in patients with chronic heart failure. Methods-19 patients with chronic heart failure were enrolled in the study. Rest calf blood flow and femoral occlusion induced calf blood flow changes were measured by venous occlusion plethysmography before and after intravenous infusion of 10% L-arginine solution (5 ml/kg for 30 minutes) or placebo. Postexercise calf blood flow was also measured after the experimental infusion. During both postinfusion periods, several exercise capacity indices were determined by a symptom limited cardiopulmonary exercise test using a bicycle ergometer. Results-Baseline calf blood flow, systemic blood pressure, and heart rate showed no significant changes in either of the two experimental conditions. However, the occlusion induced blood flow response was significantly enhanced by L-arginine infusion (mean (SEM) peak flow, 19.6 (1.5) v 28.9 (3.1) ml/min/dl calf tissue; p < 0.01), but not by placebo (peak flow, 19.1 (1.4) v 20.9 (1.8) ml/min/dl calf tissue; NS). Calf blood flow response after exercise was also higher after L-arginine infusion than after placebo (peak flow, 4.8 (0.4) v 6.0 (0.8) ml/min/dl calf tissue; p < 0.05). L-arginine infusion had no significant eVect compared with placebo on exercise capacity indices such as peak oxygen uptake (17.1 (1.0) v 15.8 (1.1) ml/min/kg; NS), anaerobic threshold (10.5 (0.6) v 10.4 (0.7) ml/min/kg; NS), and exercise time (296 (23) v 283 (22) s; NS). Conclusions-Acute supplementation with the nitric oxide precursor L-arginine increased lower limb reactive hyperaemia but did not lead to any significant improvement in exercise capacity in patients with chronic heart failure. (Heart 1999;81:512-517)

No effect of short-term arginine supplementation on nitric oxide production, metabolism and performance in intermittent exercise in athletes

“…However, arginine supplementation had no effect on exercise-induced NO production in our well-trained subjects. This result was in contrast to previous studies that suggested arginine supplementation could improve exercise-induced NO production and vasodilation in subjects with various cardiovascular diseases [9][10][11][13][14][15][16]. In addition, it has been reported that regular exercise training and arginine supplementation may have additive effects on improving endothelium-dependent vasodilation in chronic heart failure patients [32].…”

“…The impairment of NO production and the resulting endothelial dysfunction are the major factors that limit exercise capacity in patients with various cardiopulmonary conditions. As the result, arginine supplementation has been shown to improve exercise capacity in patients with hypercholesterolemia [9], chronic heart failure [10][11][12], pulmonary hypertension [13] and stable angina pectoris [14][15][16].…”

Does Citrulline Malate Enhance Physical Performance

“…Although the role of endothelium-derived NO in acute exercise has not been fully resolved, the ability of NO to induce vasodilation could potentially lead to increased work capacity (Maiorana et al, 2003). Studies investigating such an increase have produced mixed results (Chen et al, 2010;Kanaya et al, 1999;Wennmalm et al, 1995). Although we did not specifically measure NO, our results do not support the notion of a CM driven increase in NO leading to increased work capacity.…”

Improvement of ventricular function in systolic heart failure patients with oral L-citrulline supplementation

“…In addition, intravenous infusion of L-arginine enhanced cardiac performance in patients with severe congestive HF, mainly by affecting systemic vascular resistance [28] increasing maximum vasodilatation during reactive hyperemia and reducing peripheral resistance in patients with HF [29,30]. Although there were differences between the groups on some hemodynamic baseline characteristics, the improvement on patients' percentage of change after citrulline supplementation in contrast with those on control group, especially in stress LVEF in a short period, could be explained with an improvement in stress RVEF, increasing with this the left ventricle filling volume, but with worse peripheral vasodilatation (increase in MAT/TT index and systolic blood pressure) and hence decreasing the ejection fraction on stress.…”