Low-dose nitroglycerin improves microcirculation in hospitalized patients with acute heart failure

• Published in: European journal of heart failure Vol. 11; no. 4; pp. 386 - 390
• Main Authors: den Uil, Corstiaan A., Lagrand, Wim K., Spronk, Peter E., van der Ent, Martin, Jewbali, Lucia S.D., Brugts, Jasper J., Ince, Can, Simoons, Maarten L.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.04.2009; Oxford University Press
• Subjects: Acute Disease; Acute heart failure; Aged; Dose-Response Relationship, Drug; Female; Follow-Up Studies; Heart Failure - drug therapy; Heart Failure - physiopathology; Humans; Infusions, Intravenous; Inpatients; Male; Microcirculation; Microcirculation - drug effects; Microcirculation - physiology; Middle Aged; Nitroglycerin; Nitroglycerin - administration & dosage; Perfusion; Side-stream dark field imaging; Treatment Outcome; Vasodilator Agents - administration & dosage; Ventricular Pressure - drug effects; Ventricular Pressure - physiology; Microcirculation; Side-stream dark field imaging; Perfusion; Nitroglycerin; Acute heart failure
• ISSN: 1388-9842; 1879-0844
• DOI: 10.1093/eurjhf/hfp021

Aims Impaired tissue perfusion is often observed in patients with acute heart failure. We tested whether low-dose nitroglycerin (NTG) improves microcirculatory perfusion in patients admitted for acute heart failure. Methods and results In 20 acute heart failure patients, NTG was given as intravenous infusion at a fixed dose of 33 µg/min. Using Sidestream Dark Field (SDF) imaging, sublingual microvascular perfusion was evaluated before (T0, average of two baseline measurements) and 15 min after initiation of NTG (T1). In a subgroup of seven patients, SDF measurements were repeated after NTG had been stopped for 20 min. Capillaries were defined as microvessels with a diameter of <20 µm. Perfused capillary density (PCD) was determined as the parameter of tissue perfusion. Values are expressed as median and interquartile range (P25; P75). The median age of the subjects was 60 (52; 73) years, and 65% were male. Patients were stable before starting NTG. Nitroglycerin decreased central venous pressure [17 (13; 19) mmHg at T0 vs. 16 (13; 17) mmHg at T1, P = 0.03] and pulmonary capillary wedge pressure [23 (18; 31) mmHg at T0 vs. 19 (16; 25) mmHg at T1, P = 0.03]. It increased PCD [10.7 (9.9; 12.5) mm mm−2 at T0 vs. 12.4 (11.4; 13.6) mm mm−2 at T1, P = 0.01]. After cessation of NTG, PCD returned to baseline values (P = 0.04). Conclusion Low-dose NTG significantly reduces cardiac filling pressures and improves microvascular perfusion in patients admitted for acute heart failure.