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European Journal of Heart Failure Advance Access originally published online on February 10, 2009
European Journal of Heart Failure 2009 11(4):386-390; doi:10.1093/eurjhf/hfp021
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org.

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

Corstiaan A. den Uil1,*, Wim K. Lagrand2, Peter E. Spronk3, Martin van der Ent1, Lucia S.D. Jewbali1, Jasper J. Brugts1, Can Ince1 and Maarten L. Simoons1

1 Thoraxcenter, Erasmus Medical Center, Department of Cardiology and Intensive Care, Room V-017, 's-Gravendijkwal 230, NL-3015 CE Rotterdam, The Netherlands
2 Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands
3 Gelre Hospitals, Department of Intensive Care, Apeldoorn, The Netherlands

* Corresponding author. Tel: +31 10 70 35019, Fax: +31 10 70 32890, Email: c.denuil{at}erasmusmc.nl


  Abstract

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.

Key Words: Acute heart failure • Microcirculation • Nitroglycerin • Perfusion • Side-stream dark field imaging

Received October 6, 2008; Revised November 26, 2008; Accepted December 10, 2008


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