d-Ribose aids heart failure patients with preserved ejection fraction and diastolic dysfunction: a pilot study

Abstract

Objectives The incidence of heart failure continues to escalate with >550,000 newly diagnosed patients annually worldwide. More than half of the patients with heart failure have preserved ejection fraction or isolated diastolic dysfunction, for which no current effective therapies for diastolic dysfunction exist. Every cell requires adequate levels of high energy phosphates to maintain integrity and function. Previous studies have demonstrated that diastolic function is energy dependent and supplemental D-ribose has shown to improve diastolic dysfunction. This study investigated what role D-ribose might play in congestive heart failure patients with preserved systolic function and diastolic dysfunction. Methods A total of 11 patients, New York Heart Association class II–IV, with clinical symptoms, normal left ventricular systolic function and echocardiographic evidence of diastolic dysfunction were enrolled after meeting inclusion criteria. Each patient received oral D-ribose (5 g/dose) for 6 weeks. Echocardiographic evaluation, cardiopulmonary metabolic testing and subjective questionnaire assessment were performed at baseline, 6 weeks and at 9 weeks (3 weeks after discontinuing D-ribose). Results An improvement in their tissue Doppler velocity (E′), which was maintained at 9 weeks, was demonstrated in 64% of the patients. Five patients showed an improvement in their ratio of early diastolic filling velocity (E) to early annulus relaxation velocity (E′). There was no appreciable difference in these measurements during valsalva or with leg raising and handgrip exercises. Four patients also had an improvement in their maximum predicted VO2 values; two demonstrated a worsening effect and no differences were noted in the remaining patients. Subjective assessment revealed a benefit in only one patient, worsening symptoms in one patient and no change in the remaining cohort. Conclusions This pilot study revealed some beneficial trends with D-ribose even with this small cohort size. However, future investigations are necessary to further substantiate these observed benefits.

A Randomized, Double-Blind, Placebo-Controlled Study to Evaluate the Effectiveness of a Food Supplement Containing Creatine and D-Ribose Combined with a Physical Exercise Program in Increasing Stress Tolerance in Patients with Ischemic Heart Disease

“…The researchers found an improvement in the tissue Doppler velocity (E ) and an improvement in the ratio of early diastolic filling velocity (E) to early annulus relaxation velocity (E ). Four patients also had an improvement in their maximum predicted VO2 values [21].…”

“…The clinical benefits of exercise are the result of a complex web of interrelated physiologic mechanisms, each having a potentially unique exercise dose-response relationship. Some of these physiologic responses and adaptations to exercise include the following: improved weight control and body composition, improved lipid and lipoprotein profiles, improved blood glucose homeostasis and insulin sensitivity, improved fibrinolysis and thrombolysis capacity, improved coronary blood flow and arrhythmic threshold, improved endothelial function and blood pressure regulation, and lower levels of circulating inflammatory and thrombogenic factors [21]. Longitudinal studies involving individuals with CVD show that aerobic exercise training in combination with diet and other risk-factor interventions can prevent the progression, and perhaps reduce the severity, of atherosclerosis [22].…”

“…All patients were tracked in a lab designed for the secondary prevention of cardiovascular disease. Secondary prevention is defined as a series of coordinated actions designed to eliminate or minimize the impact of cardiovascular disease and related disabilities on an individual's life through lifestyle changes that include proper nutrition, constant and controlled physical activity, and reduction of risk factors [21].…”

Clinical Significance and Applications of D-Ribose in Cardiovascular Disease

“…They found in NYHA class II-IV patients with normal left ventricular systolic function and echocardiographic evidence of diastolic dysfunction that supplementation of DR (5 gms/dose) for 6 weeks revealed an improvement in their tissue Doppler velocity values (E') in 64% of the patients and some patients (45%) showed in improvement in their early diastolic filling velocity to early annulus relaxation velocity ratio (E/E'). In addition, 36% of the study patients had an improvement in their maximum predicted VO 2 measurements [44].…”

Impaired Myocardial Bioenergetics in HFpEF and the Role of Antioxidants

“…However, exercise may not change the patient’s systolic or diastolic function [ 29 - 31 ]. Adjunctive therapy such as omega-3 polyunsaturated fatty acids [ 32 , 33 ], coenzyme Q10 [ 34 ], and D-ribose [ 35 ] supplementation have been found useful for reducing the symptoms of HFpEF. Further research is needed because the recommended management of HFpEF has not been effective in reversing the poor prognosis for these patients.…”