Endogenous nitric oxide in patients with chronic heart failure (CHF): relation to functional impairment and nitrate-containing therapies

Clini, Enrico; Volterrani, Maurizio; Pagani, Marco; Bianchi, Luca; Porta, Roberto; Gilè, L. S.; Giordano, Amerigo; Ambrosino, Nicolino

doi:10.1016/s0167-5273(00)00211-4

Cited by 22 publications

(18 citation statements)

References 23 publications

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“…However, both the baseline value and the magnitude of the increase following NO 3 − intake were slightly, but significantly (P<0.05), lower than those we found recently in a parallel study of healthy, younger men and women (17). The former is consistent with previous studies of patients with systolic HF (27,28). This reduction in breath NO has been shown to be predictive of reduced exercise capacity (28) and increased mortality risk in this population (29).…”

Section: Discussionsupporting

confidence: 93%

Acute Dietary Nitrate Intake Improves Muscle Contractile Function in Patients With Heart Failure

Coggan¹,

Leibowitz²,

Spearie³

et al. 2015

Circ: Heart Failure

110

122

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Background Skeletal muscle strength, velocity, and power are markedly reduced in heart failure (HF) patients, which contributes to their impaired exercise capacity and lower quality of life. This muscle dysfunction may be partially due to decreased nitric oxide (NO) bioavailability. We therefore sought to determine whether ingestion of inorganic nitrate (NO3−) would increase NO production and improve muscle function in patients with HF due to systolic dysfunction. Methods and Results Using a double-blind, placebo-controlled, randomized crossover design, we determined the effects of dietary NO3− in nine HF patients. After fasting overnight, subjects drank beetroot juice containing or devoid of 11.2 mmol NO3−. Two hours later, muscle function was assessed using isokinetic dynamometry. Dietary NO3− increased (P<0.05–0.001) breath NO by 35–50%. This was accompanied by 9% (P=0.07) and 11% (P<0.05) increases in peak knee extensor power at the two highest movement velocities tested (i.e., 4.71 and 6.28 rad/s). Maximal power (calculated by fitting peak power data with a parabola) was therefore greater (i.e., 4.74±0.41 vs. 4.20±0.33 W/kg; P<0.05) after dietary NO3− intake. Calculated maximal velocity of knee extension was also higher following NO3− ingestion (i.e., 12.48±0.95 vs. 11.11±0.53 rad/s; P<0.05). Blood pressure was unchanged, and no adverse clinical events occurred. Conclusions In this pilot study, acute dietary NO3− intake was well-tolerated and enhanced NO bioavailability and muscle power in patients with systolic HF. Larger-scale studies should be conducted to determine whether the latter translates into an improved quality of life in this population. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01682356.

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Section: Discussionsupporting

confidence: 93%

Acute Dietary Nitrate Intake Improves Muscle Contractile Function in Patients With Heart Failure

Coggan¹,

Leibowitz²,

Spearie³

et al. 2015

Circ: Heart Failure

110

122

View full text Add to dashboard Cite

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“…This study confirms previous observations (Adachi et al, 1997;Sumino et al, 1998;Clini et al, 2000;Lovell et al, 2000) that eNO at rest is lower in HF patients compared with normal subjects and shows that during exercise eNO does not decrease as it does in normal subjects. A good correlation have been found beetwen eNO changes during exercise and peak VO2.…”

Section: Discussionsupporting

confidence: 92%

Exhaled Nitric Oxide and Exercise Performance in Heart Failure

Agostoni¹,

Bussotti²

2003

Archives of Physiology and Biochemistry

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Background.In heart failure abnormalities of pulmonary function are frequently observed particularly during exercise, which is characterized by hyperpnea, low tidal volume, early expiratory flow limitation and reduced lung compliance. Exhaled nitric oxide (NO) is increased in asthma. We evaluated whether a correlation between exhaled NO and lung mechanics exists during exercise in heart failure. Methods.We studied 33 chronic heart failure patients and 11 healthy subjects with: a) standard pulmonary function, b) lung diffusion for carbon monoxide (DLCO) including its subcomponents, capillary volume and membrane resistance and eNO both at rest and during light exercise, c) maximal cycloergometer cardiopulmonary exercise test.Results. Forced expiratory volume in 1 second (FEV 1 ) was reduced in heart failure patients (83 ± 17% of predicted) as was DLCO (75 ± 18% of predicted) due to reduced membrane resistance (32.6 ± 10.3 ml/mmHg/min vs. 39.9 ± 6.9 in patients vs. controls, p < 0.02). eNO was lower in patients vs. controls (9.7 ± 5.4 ppm vs. 14.4 ± 6.4, p < 0.05) and was, during exercise, constant in patients and reduced in controls. No significant correlation was found between eNO and lung function. Vice-versa eNO changes during exercise were correlated with peak exercise oxygen consumption (r = 0.560, p < 0.001).Conclusions. The hypothesis of a link between eNO and lung function in heart failure was not proved. The correlation between eNO changes during exercise and peak VO 2 might be due to hemoglobin oxygenation which binds NO to hemoglobin.

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“…36,43,44 In patients with CHF, decreased exhaled NO production during exercise is associated with increased pulmonary vascular resistance and decreased maximal aerobic capacity. 41,[45][46][47][48] Decreased exhaled NO production in patients with CHF may be attributed to decreased diffusion/transport of NO from lower-airway sources and/or a reduced rate of cellular production of NO in the lower respiratory tract. 4,40,49 -52 Increased mortality risk in association with decreased exhaled NO production could be related to autonomic dysregulation of ventilation during exercise, progression of right ventricular dysfunction in response to increased pulmonary vascular resistance, or other hemodynamic factors associated with decreased aerobic capacity.…”

Section: Discussionmentioning

confidence: 99%

Vascular Endothelial Dysfunction and Mortality Risk in Patients With Chronic Heart Failure

et al. 2005

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Background-Endothelial function is known to be impaired in subjects with chronic heart failure (CHF), but the association between endothelial function and subsequent mortality risk in CHF has not been previously reported. Methods and Results-Biomarkers of endothelial function in the systemic arterial circulation (flow-mediated dilation [FMD] in the brachial artery) and the pulmonary circulation (exhaled nitric oxide [NO] production during submaximal exercise) were prospectively assessed in 259 subjects with New York Heart Association class II-III CHF. In subjects with FMD measurements (nϭ149), there were 12 deaths and 5 urgent transplantations over a median follow-up period of 841 days. In subjects with exhaled NO production measurements (nϭ110), there were 18 deaths and 1 urgent transplantation over a median follow-up period of 396 days. Both decreased FMD and decreased exhaled NO production were associated with increased risk of death or urgent transplantation after adjustment for other known CHF prognostic

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Endogenous nitric oxide in patients with chronic heart failure (CHF): relation to functional impairment and nitrate-containing therapies

Cited by 22 publications

References 23 publications

Acute Dietary Nitrate Intake Improves Muscle Contractile Function in Patients With Heart Failure

Acute Dietary Nitrate Intake Improves Muscle Contractile Function in Patients With Heart Failure

Exhaled Nitric Oxide and Exercise Performance in Heart Failure

Vascular Endothelial Dysfunction and Mortality Risk in Patients With Chronic Heart Failure

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