Effects of sildenafil on ventricular and vascular function in heart failure with preserved ejection fraction.
Effects of sildenafil on ventricular and vascular function in heart failure with preserved ejection fraction.
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DOI：
10.1161/circheartfailure.114.001915
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发表时间：
2015-05
期刊：
影响因子：
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通讯作者：
Redfield MM
中科院分区：
文献类型：
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作者：
Borlaug BA;Lewis GD;McNulty SE;Semigran MJ;LeWinter M;Chen H;Lin G;Deswal A;Margulies KB;Redfield MM
Early studies showed beneficial effects of phosphodiesterase 5 inhibitors (PDE5i) on cardiovascular function in heart failure (HF) patients, but the RELAX trial observed no improvement in exercise capacity with sildenafil treatment in subjects with HF and preserved ejection fraction (HFpEF). A subgroup of participants in the RELAX trial (n=48) underwent comprehensive noninvasive cardiovascular assessment before and after treatment with sildenafil or placebo in a prospective ancillary study. Left ventricular (LV) contractility was assessed by peak power index (PWR/EDV) and stroke work index (SW/EDV). Systemic arterial load was assessed by arterial elastance (Ea) and right ventricular afterload by pulmonary artery systolic pressure (PASP). Endothelial function was assessed by reactive hyperemia index (RHI) following upper arm cuff occlusion. Compared to placebo (n=25), sildenafil (n=23) decreased Ea (−0.29±0.28mmHg/ml vs +0.02±0.29, p=0.008) and tended to improve RHI (+0.30±0.45 vs −0.17±0.30, p=0.054). In contrast, LV contractility was reduced by 11–16% with sildenafil compared to placebo (ΔPWR/EDV −52±70 vs +0±40 mmHg/s, p=0.006; ΔSW/EDV +0.3±5.8 vs −6.0±5.1 mmHg, p=0.04). Sildenafil had no effect on PASP. In subjects with HFpEF, sildenafil displayed opposing effects on ventricular and vascular function. We speculate that beneficial effects of PDE5i in the systemic vasculature and endothelium were insufficient to improve clinical status, or that the deleterious effects on left ventricular function offset any salutary vascular effects, contributing to the absence of benefit observed with sildenafil in subjects with HFpEF in the RELAX trial. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00094302.
