This Article Full Text Full Text (PDF) All Versions of this Article: 106/9/1097    most recent 01.CIR.0000027149.83473.B6v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Bocchi, E. A. Articles by Ramires, J. F. Search for Related Content PubMed PubMed Citation Articles by Bocchi, E. A. Articles by Ramires, J. F. Related Collections Congestive Exercise/exercise testing/rehabilitation

(Circulation. 2002;106:1097.)
© 2002 American Heart Association, Inc.

Clinical Investigation and Reports

Sildenafil Effects on Exercise, Neurohormonal Activation, and Erectile Dysfunction in Congestive Heart Failure

A Double-Blind, Placebo-Controlled, Randomized Study Followed by a Prospective Treatment for Erectile Dysfunction

Edimar Alcides Bocchi, MD; Guilherme Guimarães, PhD; Amilcar Mocelin, MD; Fernando Bacal, MD; Giovanni Bellotti, MD; José Franchini Ramires, MD

From the Heart Failure Clinics, Heart Institute, São Paulo University Medical School, São Paulo, Brazil.

Correspondence to Edimar Alcides Bocchi, MD, Rua Oscar Freire n2077, apto 161, São Paulo, Brazil. E-mail dcledimar{at}incor.usp.br

Background— Erectile dysfunction (ED) is common in patients with congestive heart failure (CHF). ED reduces quality of life, and it may affect compliance, thereby impairing the success of CHF treatment.

Methods and Results— In the first phase (fixed-dose double-blind, randomized, placebo-controlled, two-way crossover study), we studied in 23 men with CHF the effects of 50 mg sildenafil on exercise and neurohormonal activation. Patients underwent a treadmill 6-minute cardiopulmonary walking (6'WT) test followed by a maximal cardiopulmonary exercise test (ET). In the second phase, patients received sildenafil, taken as required for ED. Sildenafil reduced the heart rate (HR) (bpm) before the 6'WT (from 75±15 to 71±14, P=0.02) and ET (from 75±15 to 71±15, P=0.02); the systolic blood pressure (mm Hg) before the 6'WT (from 116±18 to 108±18, P=0.004) and ET (from 116±15 to 108±17, P=0.001); the diastolic blood pressure before the 6'WT (from 69±9 to 63±11, P=0.01) and ET (from 70±8 to 65±10, P=0.004); and the Ve/VCO₂ slope during the 6'WT (from 32±7 to 31±6, P=0.04) and ET (from 33±8 to 31±5, P=0.03). Sildenafil attenuated the HR increment during the 6'WT (P=0.003) and ET (P=0.000). Sildenafil increased the peak ^· O₂ from 16.6±3.4 to 17.7±3.4 mL/kg per min (P=0.025) and the exercise time from 12.3±3.4 to 13.7±3.2 minutes (P=0.003). Sildenafil improved most scores of International Index of Erectile Function.

Conclusions— Sildenafil was tolerated and effective for ED treatment in CHF, and improved the exercise capacity. The reduction of HR during exercise with sildenafil could theoretically decrease the myocardial oxygen consumption during sexual activity.

Key Words: heart failure • exercise • nitric oxide

This article has been cited by other articles:

				L Guidetti, G P Emerenziani, M C Gallotta, F Pigozzi, L Di Luigi, and C Baldari Effect of tadalafil on anaerobic performance indices in healthy athletes Br. J. Sports Med., February 1, 2008; 42(2): 130 - 133. [Abstract] [Full Text] [PDF]

				M. Guazzi, M. Samaja, R. Arena, M. Vicenzi, and M. D. Guazzi Long-Term Use of Sildenafil in the Therapeutic Management of Heart Failure J. Am. Coll. Cardiol., November 27, 2007; 50(22): 2136 - 2144. [Abstract] [Full Text] [PDF]

				G. D. Lewis, R. Shah, K. Shahzad, J. M. Camuso, P. P. Pappagianopoulos, J. Hung, A. Tawakol, R. E. Gerszten, D. M. Systrom, K. D. Bloch, et al. Sildenafil Improves Exercise Capacity and Quality of Life in Patients With Systolic Heart Failure and Secondary Pulmonary Hypertension Circulation, October 2, 2007; 116(14): 1555 - 1562. [Abstract] [Full Text] [PDF]

				G. D. Lewis, J. Lachmann, J. Camuso, J. J. Lepore, J. Shin, M. E. Martinovic, D. M. Systrom, K. D. Bloch, and M. J. Semigran Sildenafil Improves Exercise Hemodynamics and Oxygen Uptake in Patients With Systolic Heart Failure Circulation, January 2, 2007; 115(1): 59 - 66. [Abstract] [Full Text] [PDF]

				E. R. Schwarz, S. Rastogi, V. Kapur, N. Sulemanjee, and J. J. Rodriguez Erectile Dysfunction in Heart Failure Patients J. Am. Coll. Cardiol., September 19, 2006; 48(6): 1111 - 1119. [Abstract] [Full Text] [PDF]

				W. Kiowski, H. Brunner, and C. Schalcher Sex, the heart, and heart failure. Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2006; 10(3): 256 - 258. [Abstract] [PDF]

				B. A. Borlaug, V. Melenovsky, T. Marhin, P. Fitzgerald, and D. A. Kass Sildenafil Inhibits {beta}-Adrenergic-Stimulated Cardiac Contractility in Humans Circulation, October 25, 2005; 112(17): 2642 - 2649. [Abstract] [Full Text] [PDF]

				J. J. Lepore, A. Maroo, L. M. Bigatello, G. W. Dec, W. M. Zapol, K. D. Bloch, and M. J. Semigran Hemodynamic Effects of Sildenafil in Patients With Congestive Heart Failure and Pulmonary Hypertension: Combined Administration With Inhaled Nitric Oxide Chest, May 1, 2005; 127(5): 1647 - 1653. [Abstract] [Full Text] [PDF]

				T. Gori, S. Sicuro, S. Dragoni, G. Donati, S. Forconi, and J. D. Parker Sildenafil Prevents Endothelial Dysfunction Induced by Ischemia and Reperfusion via Opening of Adenosine Triphosphate-Sensitive Potassium Channels: A Human In Vivo Study Circulation, February 15, 2005; 111(6): 742 - 746. [Abstract] [Full Text] [PDF]

				M. Guazzi, G. Tumminello, F. Di Marco, C. Fiorentini, and M. D. Guazzi The effects of phosphodiesterase-5 inhibition with sildenafil on pulmonary hemodynamics and diffusion capacity, exercise ventilatory efficiency, and oxygen uptake kinetics in chronic heart failure J. Am. Coll. Cardiol., December 21, 2004; 44(12): 2339 - 2348. [Abstract] [Full Text] [PDF]

				S. G. Raja and S. H. Nayak Sildenafil: Emerging Cardiovascular Indications Ann. Thorac. Surg., October 1, 2004; 78(4): 1496 - 1506. [Abstract] [Full Text] [PDF]

				K. M. Fox, U. Thadani, P. T.S. Ma, S. D. Nash, Z. Keating, M. A. Czorniak, H. Gillies, M. Keltai, and on behalf of the CAESAR I investigators Sildenafil citrate does not reduce exercise tolerance in men with erectile dysfunction and chronic stable angina Eur. Heart J., December 2, 2003; 24(24): 2206 - 2212. [Abstract] [Full Text] [PDF]

				C. Vlachopoulos, K. Hirata, and M. F O'Rourke Effect of sildenafil on arterial stiffness and wave reflection Vascular Medicine, November 1, 2003; 8(4): 243 - 248. [Abstract] [PDF]

				T. Reffelmann and R. A. Kloner Effects of sildenafil on myocardial infarct size, microvascular function, and acute ischemic left ventricular dilation Cardiovasc Res, August 1, 2003; 59(2): 441 - 449. [Abstract] [Full Text] [PDF]

				T. Reffelmann and R. A. Kloner Therapeutic Potential of Phosphodiesterase 5 Inhibition for Cardiovascular Disease Circulation, July 15, 2003; 108(2): 239 - 244. [Full Text] [PDF]

				Sildenafil Improves Exercise Capacity and Erectile Dysfunction in CHF Journal Watch Cardiology, October 25, 2002; 2002(1025): 5 - 5. [Full Text]