scholarly journals The Effect of Dietary Inorganic Nitrate Supplementation on Cardiac Function during Submaximal Exercise in Men with Heart Failure with Reduced Ejection Fraction (HFrEF): A Pilot Study

Nutrients ◽  
2020 ◽  
Vol 12 (7) ◽  
pp. 2132
Author(s):  
Mary N. Woessner ◽  
Itamar Levinger ◽  
Jason D. Allen ◽  
Luke C. McIlvenna ◽  
Christopher Neil
Keyword(s):  
Heart Failure ◽  
Cardiac Output ◽  
Pilot Study ◽  
Ejection Fraction ◽  
Cardiac Function ◽  
Submaximal Exercise ◽  
Exercise Intolerance ◽  
Reduced Ejection Fraction ◽  
Inorganic Nitrate ◽  
Nitrate Supplementation

Heart failure with reduced ejection fraction (HFrEF) is a common end point for patients with coronary artery disease and it is characterized by exercise intolerance due, in part, to a reduction in cardiac output. Nitric oxide (NO) plays a vital role in cardiac function and patients with HFrEF have been identified as having reduced vascular NO. This pilot study aimed to investigate if nitrate supplementation could improve cardiac measures during acute, submaximal exercise. Five male participants (61 ± 3 years) with HFrEF (EF 32 ± 2.2%) completed this pilot study. All participants supplemented with inorganic nitrate (beetroot juice) or a nitrate-depleted placebo for ~13 days prior to testing. Participants completed a three-stage submaximal exercise protocol on a recumbent cycle ergometer with simultaneous echocardiography for calculation of cardiac output (Q), stroke volume (SV), and total peripheral resistance (TPR). Heart rate and blood pressure were measured at rest and during each stage. Both plasma nitrate (mean = ~1028%, p = 0.004) and nitrite (mean = ~109%, p = 0.01) increased following supplementation. There were no differences between interventions at rest, but the percent change in SV and Q from rest to stage two and stage three of exercise was higher following nitrate supplementation (all p > 0.05, ES > 0.8). Both interventions showed decreases in TPR during exercise, but the percent reduction TPR in stages two and three was greater following nitrate supplementation (p = 0.09, ES = 0.98 and p = 0.14, ES = 0.82, respectively). There were clinically relevant increases in cardiac function during exercise following supplementation with nitrate. The findings from this pilot study warrant further investigation in larger clinical trials.

scholarly journals Effect of inorganic nitrate on exercise capacity, mitochondria respiration, and vascular function in heart failure with reduced ejection fraction

2020 ◽  
Vol 128 (5) ◽  
pp. 1355-1364 ◽  
Author(s):  
Mary N. Woessner ◽  
Christopher Neil ◽  
Nicholas J. Saner ◽  
Craig A. Goodman ◽  
Luke C. McIlvenna ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Exercise Capacity ◽  
Mitochondrial Respiration ◽  
Vascular Function ◽  
Reduced Ejection Fraction ◽  
Inorganic Nitrate ◽  
Patients With Heart Failure ◽  
Nitrate Supplementation ◽  
Plasma Nitrite

This is the largest study to date to examine the effects of inorganic nitrate supplementation in patients with heart failure with reduced ejection fraction (HFrEF) and the first to include measures of vascular function and mitochondrial respiration. Although daily supplementation increased plasma nitrite, our data indicate that supplementation with inorganic nitrate as a standalone treatment is ineffective at improving exercise capacity, vascular function, or mitochondrial respiration in patients with HFrEF.

scholarly journals Dietary Inorganic Nitrate Supplementation And Exercise Tolerance In Patients With Reduced Ejection Fraction Heart Failure

2020 ◽  
Vol 52 (7S) ◽  
pp. 341-341
Author(s):  
Jason D. Allen ◽  
Christopher Neil ◽  
Luke C. McIlvenna ◽  
Joaquin Ortiz de Zevallos ◽  
Itamar Levinger ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Exercise Tolerance ◽  
Reduced Ejection Fraction ◽  
Inorganic Nitrate ◽  
Nitrate Supplementation

scholarly journals Dietary Inorganic Nitrate Supplementation And Ventilatory Threshold In Patients With Reduced Ejection Fraction Heart Failure

2020 ◽  
Vol 52 (7S) ◽  
pp. 340-340
Author(s):  
Joaquin Ortiz de Zevallos ◽  
Christopher Neil ◽  
Luke C. McIlvenna ◽  
Itamar Levinger ◽  
Jason D. Allen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Ventilatory Threshold ◽  
Reduced Ejection Fraction ◽  
Inorganic Nitrate ◽  
Nitrate Supplementation

scholarly journals Use of Free-Living Step Count Monitoring for Heart Failure Functional Classification: Validation Study (Preprint)

2018 ◽  
Author(s):  
Jonathan-F. Baril ◽  
Simon Bromberg ◽  
Yasbanoo Moayedi ◽  
Babak Taati ◽  
Cedric Manlhiot ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pilot Study ◽  
Ejection Fraction ◽  
Functional Class ◽  
Step Count ◽  
Functional Classification ◽  
Free Living ◽  
Reduced Ejection Fraction ◽  
Nyha Functional Class ◽  
Daily Total

BACKGROUND The New York Heart Association (NYHA) functional classification system has poor inter-rater reproducibility. A previously published pilot study showed a statistically significant difference between the daily step counts of heart failure (with reduced ejection fraction) patients classified as NYHA functional class II and III as measured by wrist-worn activity monitors. However, the study’s small sample size severely limits scientific confidence in the generalizability of this finding to a larger heart failure (HF) population. OBJECTIVE This study aimed to validate the pilot study on a larger sample of patients with HF with reduced ejection fraction (HFrEF) and attempt to characterize the step count distribution to gain insight into a more objective method of assessing NYHA functional class. METHODS We repeated the analysis performed during the pilot study on an independently recorded dataset comprising a total of 50 patients with HFrEF (35 NYHA II and 15 NYHA III) patients. Participants were monitored for step count with a Fitbit Flex for a period of 2 weeks in a free-living environment. RESULTS Comparing group medians, patients exhibiting NYHA class III symptoms had significantly lower recorded 2-week mean daily total step count (3541 vs 5729 [steps], P=.04), lower 2-week maximum daily total step count (10,792 vs 5904 [steps], P=.03), lower 2-week recorded mean daily mean step count (4.0 vs 2.5 [steps/minute], P=.04,), and lower 2-week mean and 2-week maximum daily per minute step count maximums (88.1 vs 96.1 and 111.0 vs 123.0 [steps/minute]; P=.02 and .004, respectively). CONCLUSIONS Patients with NYHA II and III symptoms differed significantly by various aggregate measures of free-living step count including the (1) mean and (2) maximum daily total step count as well as by the (3) mean of daily mean step count and by the (4) mean and (5) maximum of the daily per minute step count maximum. These findings affirm that the degree of exercise intolerance of NYHA II and III patients as a group is quantifiable in a replicable manner. This is a novel and promising finding that suggests the existence of a possible, completely objective measure of assessing HF functional class, something which would be a great boon in the continuing quest to improve patient outcomes for this burdensome and costly disease.

Chronic heart failure diagnosis: HFpEF

ESC CardioMed ◽  
2018 ◽  
pp. 1762-1768
Author(s):  
Daniel N. Silverman ◽  
Sanjiv J. Shah
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Cardiopulmonary Exercise Testing ◽  
Clinical History ◽  
Right Heart Catheterization ◽  
Clinical Syndrome ◽  
Exercise Intolerance ◽  
Heart Catheterization ◽  
Reduced Ejection Fraction ◽  
Treatment Measures

Heart failure (HF) with preserved ejection fraction (HFpEF) is a very common clinical syndrome that is often misdiagnosed or overlooked due to diagnostic challenges with the lack of a specific imaging test or biomarker to make a conclusive diagnosis. Unlike HF with reduced ejection fraction, neither a reduced ejection fraction nor a dilated left ventricle is available to easily make the diagnosis of HFpEF. Furthermore, while echocardiographic evidence of diastolic dysfunction is common in patients with HFpEF, it is not a universal phenomenon. Even natriuretic peptides, which are generally thought to have good negative predictive value for the diagnosis of HF, are frequently not elevated in HFpEF patients. Finally, the cardinal symptoms of HFpEF such as dyspnoea and exercise intolerance are non-specific and may be due to many of the co-morbidities present in patients in whom the HFpEF diagnosis is entertained. This chapter presents a step-wise approach utilizing a careful clinical history, physical examination, natriuretic peptide testing, and echocardiography, which can reliably provide appropriate information to rule in or rule out the HFpEF diagnosis in the majority of patients. If there is still a question about the diagnosis, or if initial general treatment measures for the HF syndrome do not result in clinical improvement, additional testing such as right heart catheterization or cardiopulmonary exercise testing can be performed to further confirm the diagnosis. With a systematic approach to the patient with dyspnoea, the accurate diagnosis of HFpEF can be made reliably so that these high-risk patients can be appropriately treated.

Mineralocorticoid receptor antagonists in heart failure with reduced ejection fraction

2020 ◽  
Vol 15 (9) ◽  
pp. 1-9
Author(s):  
Kate O'Donovan
Keyword(s):  
Heart Failure ◽  
Cardiac Output ◽  
Adverse Effects ◽  
Ejection Fraction ◽  
Mineralocorticoid Receptor ◽  
Left Ventricular ◽  
Mineralocorticoid Receptor Antagonists ◽  
Renin Angiotensin Aldosterone System ◽  
Renin Angiotensin ◽  
Reduced Ejection Fraction

Heart failure with reduced ejection fraction is associated with decreased functional capacity, poor quality of life and increased mortality risk. The neurohormonal compensatory response to a reduced cardiac output is mainly comprised of the sympathetic nervous system, natriuretic peptides and the renin–angiotensin–aldosterone system, which attempt to maintain peripheral perfusion. The renin–angiotensin–aldosterone system is an integral mechanism in increasing afterload by promoting angiotensin II-mediated vasoconstriction and increasing preload via the secretion of aldosterone which causes sodium and water retention. Albeit compensatory mechanisms attempt to increase cardiac output and perfusion, their effects are maladaptive as left ventricular function deteriorates in response to an increased afterload, preload and ventricular remodelling. In an attempt to interrupt this vicious circle, first-line pharmacological therapy in the treatment of heart failure is beta blockade and inhibition of the renin–angiotensin–aldosterone system. Integral to this treatment strategy are mineralocorticoid receptor antagonists, also known as aldosterone antagonists. This class of drug inhibits the action of aldosterone, decreases preload and reduces left ventricular workload, thus preserving ventricular function. This translates into reduced mortality incidence, decreased episodes of hospitalisations for cardiac causes and improvement in clinical signs and symptoms. Although patient benefits are explicit, adverse effects such as hyperkalaemia and renal impairment are associated with this therapy. Regular patient follow up and monitoring for potential adverse effects and drug interactions are essential to the success of the therapy.

scholarly journals Xiao-Qing-Long-Tang Maintains Cardiac Function during Heart Failure with Reduced Ejection Fraction in Salt-Sensitive Rats by Regulating the Imbalance of Cardiac Sympathetic Innervation

2020 ◽  
Vol 2020 ◽  
pp. 1-11
Author(s):  
Zhaoyu Li ◽  
Yongcheng Wang ◽  
Yuehua Jiang ◽  
Dufang Ma ◽  
Ping Jiang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Ejection Fraction ◽  
Cardiac Function ◽  
Sympathetic Nerve ◽  
Morphological Changes ◽  
Sympathetic Innervation ◽  
Nerve Endings ◽  
Cardiac Sympathetic Innervation ◽  
Reduced Ejection Fraction

Objective. The anatomical and functional imbalances of sympathetic nerves are associated with cardiovascular disease progression. Xiao-Qing-Long-Tang (XQLT), an ancient Chinese herbal formula, has been used to treat cardiovascular diseases in eastern Asia for thousands of years. We determined the effect of XQLT in maintaining cardiac function during heart failure with reduced ejection fraction (HFrEF) with respect to its neurobiological effects in salt-sensitive rats. Methods. Dahl salt-sensitive (DS) rats were fed a high-salt diet to establish an HFrEF model and were divided into model (DS, administered normal saline) and XQL groups (administrated XQLT) randomly, with SS-13BN rats being used as the control. The bodyweight and blood pressure of rats were observed regularly. Electrocardiogram, echocardiography, and plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) were determined to assess cardiac function. The sympathetic tune and myocardial morphological changes were evaluated. Western blot and qRT-PCR were used to assay the expression of the nerve growth factor (NGF) and leukemia inhibitory factor (LIF). Tyrosine hydroxylase (TH), choline acetyltransferase (CHAT), and growth-associated protein 43 (GAP43) were assayed to confirm sympathetic remodeling. The micromorphological changes in cardiac sympathetic nerve endings were observed by transmission electron microscopy. Results. Four weeks after XQLT treatment, cardiac function and bodyweight were higher and blood pressure was lower than that of the DS group. Myocardial noradrenaline (NA) increased, while the plasma NA level decreased significantly. The morphology demonstrated that XQLT significantly alleviated myocardial damage. XQLT decreased the expression of LIF, increased the expression of NGF, enhanced the TH+/GAP43+ and TH+/CHAT + positive nerve fiber density, and improved the TH and GAP43 protein expression, but had no effect on CHAT. Moreover, XQLT improved the micromorphology of sympathetic nerve endings in the myocardium. Conclusion. XQLT maintains cardiac function during HFrEF in salt-sensitive rats, in part, by regulating the imbalance of cardiac sympathetic innervation.

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