Short-term intravenous sodium nitrite infusion improves cardiac and pulmonary hemodynamics in heart failure patients

Research output: Contribution to journalArticle

Authors

  • Julian O M Ormerod
  • Majid Mukadam
  • Jonathan D W Evans
  • Bernadette O Fernandez
  • Robert S Bonser
  • Martin Feelisch

Colleges, School and Institutes

Abstract

BACKGROUND: Nitrite exhibits hypoxia-dependent vasodilator properties, selectively dilating capacitance vessels in healthy subjects. Unlike organic nitrates, it seems not to be subject to the development of tolerance. Currently, therapeutic options for decompensated heart failure (HF) are limited. We hypothesized that by preferentially dilating systemic capacitance and pulmonary resistance vessels although only marginally dilating resistance vessels, sodium nitrite (NaNO2) infusion would increase cardiac output but reduce systemic arterial blood pressure only modestly. We therefore undertook a first-in-human HF proof of concept/safety study, evaluating the hemodynamic effects of short-term NaNO2 infusion.

METHODS AND RESULTS: Twenty-five patients with severe chronic HF were recruited. Eight received short-term (5 minutes) intravenous NaNO2 at 10 μg/kg/min and 17 received 50 μg/kg/min with measurement of cardiac hemodynamics. During infusion of 50 μg/kg/min, left ventricular stroke volume increased (from 43.22±21.5 to 51.84±23.6 mL; P=0.003), with marked falls in pulmonary vascular resistance (by 29%; P=0.03) and right atrial pressure (by 40%; P=0.007), but with only modest falls in mean arterial blood pressure (by 4 mm Hg; P=0.004). The increase in stroke volume correlated with the increase in estimated trans-septal gradient (=pulmonary capillary wedge pressure-right atrial pressure; r=0.67; P=0.003), suggesting relief of diastolic ventricular interaction as a contributory mechanism. Directionally similar effects were observed for the above hemodynamic parameters with 10 μg/kg/min; this was significant only for stroke volume, not for other parameters.

CONCLUSIONS: This first-in-human HF efficacy/safety study demonstrates an attractive profile during short-term systemic NaNO2 infusion that may be beneficial in decompensated HF and warrants further evaluation with longer infusion regimens.

Details

Original languageEnglish
Pages (from-to)565-571
Number of pages7
JournalCirculation. Heart failure
Volume8
Issue number3
Early online date2 Apr 2015
Publication statusPublished - May 2015

Keywords

  • Adult, Arterial Pressure, Cardiac Output, Chronic Disease, Coronary Circulation, Drug Administration Schedule, England, Female, Heart Failure, Hemodynamics, Humans, Infusions, Intravenous, Male, Middle Aged, Pulmonary Circulation, Recovery of Function, Severity of Illness Index, Sodium Nitrite, Time Factors, Treatment Outcome, Vascular Resistance, Vasodilation, Vasodilator Agents