Circulation, Vol 90, 2780-2785, Copyright © 1994 by American Heart Association
E Loh, JS Stamler, JM Hare, J Loscalzo and WS Colucci
BACKGROUND: Pulmonary vascular resistance (PVR) is frequently elevated in
patients with advanced heart failure. Nitric oxide (NO), which contributes
to the activity of endothelium-derived relaxing factor, causes relaxation
of pulmonary arteries and veins in vitro. Inhalation of NO gas causes
pulmonary vasodilation in patients with primary and secondary forms of
pulmonary hypertension. METHODS AND RESULTS: To test the hypothesis that
inhalation of NO gas lowers PVR in patients with heart failure, we studied
the hemodynamic effects of a 10-minute inhalation of NO (80 ppm) in 19
patients with New York Heart Association class III (n = 5) and class IV (n
= 14) heart failure due to left ventricular (LV) dysfunction. Although
inhalation of NO had no effect on pulmonary artery pressures, the PVR
decreased by 31 +/- 7% (P < .001) due to a 23 +/- 7% increase (P <
.001) in pulmonary artery wedge pressure and despite a 4 +/- 2% (P <
.05) decrease in cardiac index. The magnitude of the decrease in PVR with
inhaled NO was inversely related (r = -.713; P < .001) to the baseline
PVR. Inhaled NO had no effect on heart rate, systemic arterial pressure,
systemic vascular resistance, or LV peak +dP/dt or -dP/dt. CONCLUSIONS: In
patients with heart failure due to LV dysfunction, inhalation of NO causes
a decrease in the PVR associated with an increase in LV filling pressure.
These findings predict that inhaled NO, if used alone at this dose (80
ppm), may have adverse effects in patients with LV failure.
ARTICLES
Cardiovascular effects of inhaled nitric oxide in patients with left ventricular dysfunction
Department of Medicine, Brigham and Women Hospital, Boston, MA 02115.
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