Renal and Hormonal Effects of Systemic Nitric Oxide Inhibition in Patients With Congestive Heart Failure and in Healthy Control Subjects |
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| Authors: | J.N. Bech J. Starklint H. Bentzen O. Nyvad E.B. Pedersen |
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| Affiliation: | 1. St Thomas Hospital, London, United Kingdom;2. Schuechtermann-Klinik, Bad Rothenfelde, Germany;3. CHU Pontchaillou, Rennes, France;4. Hopital Cardiologique, Lille, France;5. John Radcliffe Hospital, Oxford, United Kingdom;6. University Hospital of Bordeaux, Bordeaux, France;7. Herz- und Diabeteszentrum NRW, Bad Oeynhausen, Germany;10. University of Southern California, Los Angeles, California;1. Thorax Institute, Hospital Clínic, Institut d''Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain;2. Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain;3. Cardiovascular Disease Division, Pontificia Universidad Católica de Chile, Santiago, Chile;1. Cardiovascular Division, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina;2. Department of Medicine, Cooper Medical School of Rowan University, Camden, New Jersey;3. Department of Internal Medicine, Duke University School of Medicine, Durham, North Carolina;4. Department of Internal Medicine and Program of Applied Translational Research, Yale University School of Medicine, New Haven, Connecticut;1. Heart Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark;2. Department of Cardiology, Gentofte Hospital, Gentofte, Denmark;3. Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark |
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| Abstract: | BackgroundThe significance of basal renal nitric oxide (NO) availability in the regulation of renal perfusion and sodium excretion in human congestive heart failure (CHF) has not been described previously.Methods and ResultsWe studied the effects of acute systemic NO synthesis inhibition with NG-monomethyl-L-arginine (L-NMMA) in 12 patients with CHF and 10 healthy control subjects (CON) in a randomized placebo-controlled study. Effect parameters were renal plasma flow (RPF), renal vascular resistance (RVR), glomerular filtration rate (GFR), urine sodium excretion and plasma levels of vasoactive hormones. L-NMMA was associated with a significant decrease in RPF (CON-LNMMA: ?13 ± 3% [P = .014]; CHF-LNMMA: ?17 ± 7% [P = .017]) and a profound increase in RVR in both CHF and CON (CON-LNMMA: +26 ± 6% [P = .009]; CHF-LNMMA: +37 ± 70% [P = .005]). Significant decreases in sodium excretion were found in both CHF-LNMMA and CON-LNMMA. Relative changes from baseline were not statistically different between CHF-LNMMA and CON-LNMMA. After L-NMMA, RPF values correlated inversely with plasma aldosterone in CHF-LNMMA (P = .01). L-NMMA induced an increase in A-type natriuretic peptide (ANP) only in CHF-LNMMA (+18 ± 8%; P = .035), which correlated significantly with basal ANP levels (P = .034).ConclusionsThere was no difference in the renal response to L-NMMA in CHF vs CON, suggesting that the impact of NO on renal perfusion and sodium excretion is maintained in stable CHF. We suggest that NO influences the release of ANP during high levels of atrial stretch in CHF. |
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| Keywords: | Nitric oxide renal plasma flow ANP aldosterone |
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