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(Circulation. 2000;101:2066.)
© 2000 American Heart Association, Inc.

Clinical Investigation and Reports

Improvement in Exercise Capacity With Nitric Oxide Inhalation in Patients With Precapillary Pulmonary Hypertension

Toshio Hasuda, MD; Toru Satoh, MD; Akito Shimouchi, MD; Fumio Sakamaki, MD; Shingo Kyotani, MD; Takahiro Matsumoto, MD; Yoichi Goto, MD; Norifumi Nakanishi, MD

From the Division of Cardiology and Pulmonary Circulation, Department of Medicine, National Cardiovascular Center, and Division of Circulatory Dynamics, National Cardiovascular Research Institute (A.S.), Suita, Osaka, Japan.

Correspondence to Toru Satoh, MD, Cardiopulmonary Division, Department of Medicine, Keio University School of Medicine, Shinanomachi 35, Shinjukuku, Tokyo 160-8582, Japan. E-mail tsatoh{at}cpnet.med.keio.ac.jp

Background—Patients with precapillary pulmonary hypertension (PH) exhibit a poor exercise capacity due to an impaired vasodilatory response of their pulmonary arteries. By causing the pulmonary artery to dilate, inhaled nitric oxide (NO) may allow an increase in exercise capacity in patients with PH.

Methods and Results—On 2 separate days, 3 days apart, 14 patients with precapillary PH (10 primary PH, 4 residual PH after correction of an intracardiac shunt; age, 40±12 years; mean pulmonary artery pressure, 60±23 mm Hg) performed exercise, with and without inhalation of 20 ppm NO, on a cycle ergometer. The work rate was increased 15 W/min until their symptom-limited maximum, with breath-by-breath gas analysis. Patients were randomly and blindly selected to inhale NO on either their first or second test. Peak exercise load and anaerobic threshold tended to increase, but not significantly. Peak oxygen consumption (O₂) and O₂/W ratio increased significantly, by 18% and 22%, respectively (peak O₂, 13.6±3.6 to 16.0±4.1 mL · kg^-1 · min^-1; O₂/W ratio, 5.8±2.4 to 7.1±2.3 mL · kg^-1 · min^-1 · W^-1; both P<0.01). Peak O₂ increased >10% in 12 of the 14 patients. However, respiratory quotient at peak exercise decreased from 1.22±0.15 to 1.09±0.15 (P<0.01).

Conclusions—Inhaled NO substantially increases oxygen consumption at the same workload during exercise. This finding supports the possibility of ambulatory NO inhalation therapy in patients with precapillary PH.

Key Words: nitric oxide • exercise • pulmonary heart disease • hypertension

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