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Low‐dose nitroglycerin improves microcirculation in hospitalized patients with acute heart failure
Author(s) -
Uil Corstiaan A.,
Lagrand Wim K.,
Spronk Peter E.,
Ent Martin,
Jewbali Lucia S.D.,
Brugts Jasper J.,
Ince Can,
Simoons Maarten L.
Publication year - 2009
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 - 10.1093/eurjhf/hfp021
Subject(s) - medicine , interquartile range , perfusion , heart failure , cardiology , microcirculation , pulmonary wedge pressure , anesthesia
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.