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The effects of intravenous sildenafil on hemodynamics and cardiac sympathetic activity in chronic human heart failure
Author(s) -
AlHesayen Abdul,
Floras John S.,
Parker John D.
Publication year - 2006
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1016/j.ejheart.2006.03.007
Subject(s) - medicine , sildenafil , heart failure , cardiology , hemodynamics , population , erectile dysfunction , cardiac output , ejection fraction , norepinephrine , anesthesia , dopamine , environmental health
Background Erectile dysfunction is common in patients with chronic heart failure and sildenafil is an effective treatment option in this population. Sildenafil has been reported to increase sympathetic outflow in normal volunteers. To date, experience with sildenafil in patients with congestive heart failure is limited and the impact of phosphodiesterase‐5 inhibition on sympathetic activity in this population has not been evaluated. Methods and results 10 patients with heart failure (ejection fraction 23±3%) were studied. Generalized and cardiac sympathetic activity responses to an intravenous infusion of sildenafil were measured by the norepinephrine spillover method. In response to sildenafil, there was a significant reduction in mean pulmonary artery (− 26±5%, P <0.01) and mean arterial pressures (−8±1%, P <0.01). These hemodynamic responses were accompanied by a 22±5% reduction in cardiac norepinephrine spillover ( P <0.02) but no change in total body norepinephrine spillover. Conclusions The acute administration of sildenafil is associated with a modest reduction in systemic arterial blood pressure and a more substantial reduction in pulmonary arterial pressure. These hemodynamic changes are observed in the absence of systemic sympathetic activation and are associated with a reduction in cardiac norepinephrine spillover in patients with chronic heart failure. These observations are relevant given the high prevalence of erectile dysfunction in this patient population.