Skip Navigation



European Journal of Heart Failure Advance Access published online on February 10, 2009
European Journal of Heart Failure, doi:10.1093/eurjhf/hfp021
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
11/4/386    most recent
hfp021v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by den Uil, C. A.
Right arrow Articles by Simoons, M. L.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by den Uil, C. A.
Right arrow Articles by Simoons, M. L.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

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


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?




Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.