Effects of organic and inorganic nitrate on aortic and carotid haemodynamics in heart failure with preserved ejection fraction.
Effects of organic and inorganic nitrate on aortic and carotid haemodynamics in heart failure with preserved ejection fraction.
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DOI：
10.1002/ejhf.885
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发表时间：
2017-11
影响因子：
18.2
通讯作者：
Segers P
中科院分区：
文献类型：
--
作者：
Chirinos JA;Londono-Hoyos F;Zamani P;Beraun M;Haines P;Vasim I;Varakantam S;Phan TS;Cappola TP;Margulies KB;Townsend RR;Segers P
评估有机硝酸盐与无机硝酸盐给药对射血分数保留的心力衰竭 (HFpEF) 患者的血流动力学影响。我们在给予 0.4 mg 舌下含服硝酸甘油（NTG；n=26）之前和之后以无创方式评估了颈动脉和主动脉压力-流量关系，并在一项单独的子研究中评估了对 12.9 mmol 无机硝酸盐的反应（n=16）。 NTG 并没有持续减少到达近端主动脉的波反射（反射系数实部的变化，一阶谐波：-0.09；P=0.01；二阶谐波：-0.045，P=0.16；三阶谐波：+0.087；P=0.05），但在颈动脉区域产生深度血管舒张，收缩压显着降低（133.6 vs 120.5 mmHg；P=0.011），颈动脉床血管阻力（19580 vs. 13078 达因·s/cm5；P=0.001）和颈动脉特征阻抗（3440 vs. 1923 达因·s/cm5；P=0.002）显着降低。相比之下，无机硝酸盐持续减少前 3 个谐波的波反射（反射系数实部变化，第 1 次谐波：-0.12；P=0.03；第 2 次谐波：-0.11，P=0.01；第 3 次谐波：-0.087；P=0.09），并且不会降低血压、颈动脉床血管阻力或颈动脉特征阻抗 (P=NS)。 NTG 在颈动脉循环中产生显着的血管舒张作用，显着降低血压，并对中心波反射产生不一致的影响。相比之下，无机硝酸盐会持续减少波反射，并且与 NTG 不同，它不会导致明显的低血压或脑血管扩张。这些血流动力学差异可能是 HFpEF 中无机硝酸盐与有机硝酸盐对运动能力和副作用的不同影响的基础。
To assess the hemodynamic effects of organic vs. inorganic nitrate administration among patients with heart failure with preserved ejection fraction (HFpEF). We assessed carotid and aortic pressure-flow relations non-invasively before and after the administration of 0.4 mg of sublingual-nitroglycerin (NTG; n=26), and in a separate sub-study, in response to 12.9 mmol of inorganic nitrate (n=16). NTG 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 vasodilation 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 (19580 vs. 13078 dynes·s/cm5; P=0.001) and carotid characteristic impedance (3440 vs. 1923 dynes·s/cm5; P=0.002). Inorganic nitrate, in contrast, consistently reduced wave reflections across the first 3 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). NTG produces marked vasodilation 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 NTG, it does so without significant hypotension or cerebrovascular dilatation. These hemodynamic differences may underlie the different effects on exercise capacity and side effect profile of inorganic vs. organic nitrate in HFpEF.
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影响因子：
24
作者：
Chirinos, Julio A.;Kips, Jan G.;Jacobs, David R., Jr.;Brumback, Lyndia;Duprez, Daniel A.;Kronmal, Richard;Bluemke, David A.;Townsend, Raymond R.;Vermeersch, Sebastian;Segers, Patrick
通讯作者：
Segers, Patrick
影响因子：
8.3
作者：
Fok, Henry;Guilcher, Antoine;Chowienczyk, Phil
通讯作者：
Chowienczyk, Phil
DOI：
10.1016/j.jchf.2015.12.013
发表时间：
2016-06
期刊：
JACC. Heart failure
影响因子：
--
作者：
Eggebeen J;Kim-Shapiro DB;Haykowsky M;Morgan TM;Basu S;Brubaker P;Rejeski J;Kitzman DW
通讯作者：
Kitzman DW
影响因子：
8.3
作者：
Stokes, GS;Barin, ES;Gilfillan, KL
通讯作者：
Gilfillan, KL
影响因子：
--
作者：
Chirinos, Julio A;Zamani, Payman
通讯作者：
Zamani, Payman