Portal de Periódicos da CAPES

Inhaled nitric oxide improves exercise capacity in patients with severe heart failure and right ventricular dysfunction

1998; Elsevier BV; Volume: 81; Issue: 12 Linguagem: Inglês

10.1016/s0002-9149(98)00214-8

1879-1913

Todd M. Koelling, Max Kirmse, Thomas G. Di Salvo, G. William Dec, Warren M. Zapol, Marc J. Semigran,

Cardiovascular Function and Risk Factors

Previous studies have shown that vasodilators, which affect both systemic venous and pulmonary arterial circulation, improve right ventricular (RV) loading conditions and increase exercise capacity in advanced congestive heart failure (CHF). The beneficial effects of nitrates on chronic CHF may reside in their direct effects on the pulmonary vasculature. In a trial of patients with New York Heart Association classes III to IV CHF, isosorbide dinitrate resulted in sustained reductions in pulmonary arterial wedge pressure, pulmonary artery pressure, and pulmonary vascular resistance simultaneously, with improvement in symptoms and exercise capacity. 1 Leier C. Huss P. Magorien R. Unverferth D.V. Improved exercise capacity and differing arterial and venous tolerance during chronic isosorbide dinitrate therapy for congestive heart failure. Circulation. 1983; 67: 817-822 Crossref PubMed Scopus (250) Google Scholar In the VHeFT-I and VHeFT-II trials, the combination of isosorbide dinitrate and hydralazine resulted in greater exercise tolerance compared with treatment with either placebo or enalapril therapy. 2 Cohn J. Archibald D. Ziesche S. Franciosa J.A. Harston W.E. Tristani F.E. Dunkman W.B. Jacobs W. Francis G.S. Flohr K.H. Effect of vasodilator therapy on mortality in chronic congestive heart failure results of a Veterans Administration Cooperative Study. N Engl J Med. 1986; 314: 1547-1552 Crossref PubMed Scopus (2092) Google Scholar , 3 Cohn J.N. Johnson G.R. Shabetai R. Loeb H. Tristani F. Rector T. Smith R. Fletcher R. Ejection fraction, peak exercise oxygen consumption, cardiothoracic ratio, ventricular arrhythmias, and plasma norepinephrine as determinants of prognosis in heart failure. The V-HeFT VA Cooperative Studies Group. Circulation. 1993; 87: VI5-VI16 PubMed Google Scholar Although oral nitrates have beneficial effects on RV preload and afterload, their use in clinical practice is limited by hypotension, headache, and tachyphylaxis. Inhaled nitric oxide (NO) is a selective pulmonary vasodilator that has previously been shown to reduce pulmonary vascular resistance in patients with CHF without altering systemic vascular resistance. 4 Semigran M.J. Cockrill B.A. Kacmarek R. Thompson B.T. Zapol W.M. Dec G.W. Fifer M.A. Hemodynamic effects of inhaled nitric oxide in heart failure. J Am Coll Cardiol. 1994; 24: 982-988 Abstract Full Text PDF PubMed Scopus (188) Google Scholar , 5 Loh E. Stamler J.S. Hare J.M. Loscalzo J. Colucci W.S. Cardiovascular effects of inhaled nitric oxide in patients with left ventricular dysfunction. Circulation. 1994; 90: 2780-2785 Crossref PubMed Google Scholar We hypothesized that inhaled NO would improve exercise capacity in patients with severe CHF who were already receiving systemic vasodilator therapy.