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Effects of organic and inorganic nitrate on aortic and carotid haemodynamics in heart failure with preserved ejection fraction

(2017) EUROPEAN JOURNAL OF HEART FAILURE. 19(11). p.1507-1515
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Abstract
Aims To assess the haemodynamic effects of organic vs. inorganic nitrate administration among patients with heart failure with preserved ejection fraction (HFpEF). Methods and results We assessed carotid and aortic pressure-flow relations non-invasively before and after the administration of 0.4 mg of sublingual nitroglycerin (n= 26), and in a separate sub-study, in response to 12.9 mmoL of inorganic nitrate (n= 16). Nitroglycerin did not consistently reduce wave reflections arriving at the proximal aorta (change in real part of reflection coefficient, 1st harmonic: -0.09; P = 0.01; 2nd harmonic: -0.045, P = 0.16; 3rd harmonic: + 0.087; P = 0.05), but produced profound vasodilatation in the carotid territory, with a significant reduction in systolic blood pressure (133.6 vs. 120.5 mmHg; P = 0.011) and a marked reduction in carotid bed vascular resistance (19 580 vs. 13 078 dynes .s/cm(5); P = 0.001) and carotid characteristic impedance (3440 vs. 1923 dynes .s/cm(5); P = 0.002). Inorganic nitrate, in contrast, consistently reduced wave reflections across the first three harmonics (change in real part of reflection coefficient, 1st harmonic: -0.12; P = 0.03; 2nd harmonic: -0.11, P = 0.01; 3rd harmonic: -0.087; P = 0.09) and did not reduce blood pressure, carotid bed vascular resistance, or carotid characteristic impedance (P = NS). Conclusions Nitroglycerin produces marked vasodilatation in the carotid circulation, with a pronounced reduction in blood pressure and inconsistent effects on central wave reflections. Inorganic nitrate, in contrast, produces consistent reductions in wave reflections, and unlike nitroglycerin, it does so without significant hypotension or cerebrovascular dilatation. These haemodynamic differences may underlie the different effects on exercise capacity and side effect profile of inorganic vs. organic nitrate in HFpEF.
Keywords
VARYING MYOCARDIAL STRESS, NITRIC OXIDE PATHWAY, WAVE REFLECTION, ISOSORBIDE MONONITRATE, GLYCERYL TRINITRATE, BLOOD-PRESSURE, HYPERTENSION, REDUCTION, IMPEDANCE, ARTERIES, Arterial load, Cerebrovascular input impedance, Heart failure with, preserved ejection fraction, Inorganic nitrate, Organic nitrate

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Chicago
Chirinos, Julio A., Francisco Londono-Hoyos, Payman Zamani, Melissa Beraun, Philip Haines, Izzah Vasim, Swapna Varakantam, et al. 2017. “Effects of Organic and Inorganic Nitrate on Aortic and Carotid Haemodynamics in Heart Failure with Preserved Ejection Fraction.” European Journal of Heart Failure 19 (11): 1507–1515.
APA
Chirinos, J. A., Londono-Hoyos, F., Zamani, P., Beraun, M., Haines, P., Vasim, I., Varakantam, S., et al. (2017). Effects of organic and inorganic nitrate on aortic and carotid haemodynamics in heart failure with preserved ejection fraction. EUROPEAN JOURNAL OF HEART FAILURE, 19(11), 1507–1515.
Vancouver
1.
Chirinos JA, Londono-Hoyos F, Zamani P, Beraun M, Haines P, Vasim I, et al. Effects of organic and inorganic nitrate on aortic and carotid haemodynamics in heart failure with preserved ejection fraction. EUROPEAN JOURNAL OF HEART FAILURE. Hoboken: Wiley; 2017;19(11):1507–15.
MLA
Chirinos, Julio A., Francisco Londono-Hoyos, Payman Zamani, et al. “Effects of Organic and Inorganic Nitrate on Aortic and Carotid Haemodynamics in Heart Failure with Preserved Ejection Fraction.” EUROPEAN JOURNAL OF HEART FAILURE 19.11 (2017): 1507–1515. Print.
@article{8547089,
  abstract     = {Aims To assess the haemodynamic effects of organic vs. inorganic nitrate administration among patients with heart failure with preserved ejection fraction (HFpEF). Methods and results We assessed carotid and aortic pressure-flow relations non-invasively before and after the administration of 0.4 mg of sublingual nitroglycerin (n= 26), and in a separate sub-study, in response to 12.9 mmoL of inorganic nitrate (n= 16). Nitroglycerin did not consistently reduce wave reflections arriving at the proximal aorta (change in real part of reflection coefficient, 1st harmonic: -0.09; P = 0.01; 2nd harmonic: -0.045, P = 0.16; 3rd harmonic: + 0.087; P = 0.05), but produced profound vasodilatation in the carotid territory, with a significant reduction in systolic blood pressure (133.6 vs. 120.5 mmHg; P = 0.011) and a marked reduction in carotid bed vascular resistance (19 580 vs. 13 078 dynes .s/cm(5); P = 0.001) and carotid characteristic impedance (3440 vs. 1923 dynes .s/cm(5); P = 0.002). Inorganic nitrate, in contrast, consistently reduced wave reflections across the first three harmonics (change in real part of reflection coefficient, 1st harmonic: -0.12; P = 0.03; 2nd harmonic: -0.11, P = 0.01; 3rd harmonic: -0.087; P = 0.09) and did not reduce blood pressure, carotid bed vascular resistance, or carotid characteristic impedance (P = NS). Conclusions Nitroglycerin produces marked vasodilatation in the carotid circulation, with a pronounced reduction in blood pressure and inconsistent effects on central wave reflections. Inorganic nitrate, in contrast, produces consistent reductions in wave reflections, and unlike nitroglycerin, it does so without significant hypotension or cerebrovascular dilatation. These haemodynamic differences may underlie the different effects on exercise capacity and side effect profile of inorganic vs. organic nitrate in HFpEF.},
  author       = {Chirinos, Julio A. and Londono-Hoyos, Francisco and Zamani, Payman and Beraun, Melissa and Haines, Philip and Vasim, Izzah and Varakantam, Swapna and Phan, Timothy S. and Cappola, Thomas P. and Margulies, Kenneth B. and Townsend, Raymond R. and Segers, Patrick},
  issn         = {1388-9842},
  journal      = {EUROPEAN JOURNAL OF HEART FAILURE},
  language     = {eng},
  number       = {11},
  pages        = {1507--1515},
  publisher    = {Wiley},
  title        = {Effects of organic and inorganic nitrate on aortic and carotid haemodynamics in heart failure with preserved ejection fraction},
  url          = {http://dx.doi.org/10.1002/ejhf.885},
  volume       = {19},
  year         = {2017},
}

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