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(Circulation. 1999;99:2396-2401.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Effect of NO Donors on LV Diastolic Function in Patients With Severe Pressure-Overload Hypertrophy
From the Division of Cardiology, University Hospitals Zurich and Bern, Switzerland.
Correspondence to Otto M. Hess, MD, Professor of Cardiology, Swiss Heart Center, University Hospital, CH-3010 Bern, Switzerland. E-mail otto.martin.hess{at}insel.ch
Background—Previous experimental studies have shown that nitric oxide (NO) modulates cardiac function by an abbreviation of systolic contraction and an enhancement of diastolic relaxation. However, the response to NO donors of patients with severe pressure-overload hypertrophy and diastolic dysfunction is unknown.
Methods and Results—Intracoronary NO donors were
given to 17 patients with severe aortic stenosis. A
dose-response curve was obtained with nitroglycerin
(30, 90, and 150 µg) in 11 patients and sodium nitroprusside (1, 2,
and 4 µg/min) in 6. Left ventricular (LV) high-fidelity
pressure measurements with simultaneous LV angiograms were
performed at baseline and after the maximal dose of NO. The
dose-response curve for intracoronary NO donors showed a marked
fall in LV end-diastolic pressure, from 23 to 14
mm Hg (-39%; P<0.0001), whereas LV peak
systolic pressure fell only slightly, from 206 to 196
mm Hg (-4%; P<0.01). End-diastolic
chamber stiffness decreased from 0.12 to 0.07 mm Hg/mL
(P<0.0001) and end-systolic stiffness from 1.6
to 1.3 mm Hg/mL (P<0.01). Heart rate, right
atrial pressure, LV ejection fraction, the time constant of isovolumic
pressure decay (
), and LV filling rates remained unchanged.
Conclusions—In patients with severe pressure-overload hypertrophy, intracoronary NO donors exert a marked decrease in LV end-diastolic pressure without affecting LV systolic pump function. Thus, the hypertrophied myocardium appears to be particularly susceptible to NO donors, with a marked improvement in diastolic function.
Key Words: nitric oxide • nitroglycerin • sodium nitroprusside • hypertrophy • diastole
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