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

被引:52
作者
den Uil, Corstiaan A. [1 ]
Lagrand, Wim K. [2 ]
Spronk, Peter E. [3 ]
van der Ent, Martin [1 ]
Jewbali, Lucia S. D. [1 ]
Brugts, Jasper J. [1 ]
Ince, Can [1 ]
Simoons, Maarten L. [1 ]
机构
[1] Erasmus MC, Thoraxctr, Dept Cardiol & Intens Care, NL-3015 CE Rotterdam, Netherlands
[2] Univ Amsterdam, Acad Med Ctr, Dept Intens Care, NL-1105 AZ Amsterdam, Netherlands
[3] Gelre Hosp, Dept Intens Care, Apeldoorn, Netherlands
基金
美国国家卫生研究院;
关键词
Acute heart failure; Microcirculation; Nitroglycerin; Perfusion; Side-stream dark field imaging; CARDIOGENIC-SHOCK; GUIDELINES; DIAGNOSIS; SYNTHASE; NO;
D O I
10.1093/eurjhf/hfp021
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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. In 20 acute heart failure patients, NTG was given as intravenous infusion at a fixed dose of 33 mu g/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 mu m. 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). Low-dose NTG significantly reduces cardiac filling pressures and improves microvascular perfusion in patients admitted for acute heart failure.
引用
收藏
页码:386 / 390
页数:5
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