Increased Exhaled Nitric Oxide Levels After Exercise in Patients With Chronic Systolic Heart Failure With Pulmonary Venous Hypertension |
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| Authors: | Andres Schuster Akanksha Thakur Zeneng Wang Allen G. Borowski James D. Thomas W. H. Wilson Tang |
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| Affiliation: | 1. Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio;2. Department of Cell Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio;3. Department of Medicine, Stanford University School of Medicine, Stanford, California;1. Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California;2. Division of Nuclear Medicine and Molecular Imaging, Stanford University School of Medicine, Stanford, California;1. Heart Failure Clinic, Coronary Intensive Care Unit, Instituto de Cardiologia “Juana F. Cabral”, Corrientes, Argentina;2. Cardiovascular Department, Ospedale San Filippo Neri, Rome, Italy;3. Department of Cardiology, Azienda Istituti Ospitalieri, Cremona, Italy;4. Department of Cardiology, Ospedale Civile, Fossano, Italy;5. Heart Failure Unit, Department of Cardiology, Ospedale Civile, San Donà di Piave, Italy;6. Heart Failure Unit, Department of Cardiology, Ospedale Santa Maria Nuova, Florence, Italy;7. Heart Failure Unit & Coronary Intensive Care Unit, Ospedale Civile, Chioggia, Italy;1. Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium;2. Doctoral School for Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium;3. Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium;4. Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio;1. Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois;2. Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, Illinois;3. Veteran''s Affairs Medical Center and Virginia Commonwealth University Health System, Richmond, Virginia;4. Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee;5. Veteran''s Affairs Medical Center and University of California, San Diego, California;1. Division for Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway;2. Department of Medical Microbiology, Oslo University hospital, Norway;3. Division for Health Data and Digitalization, Norwegian Institute of Public Health, Oslo, Norway |
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| Abstract: | BackgroundFractional exhaled nitric oxide (eNO) is recognized as a marker of pulmonary endothelial function. Oxidative stress is associated with systemic endothelial nitric oxide production, but its correlation with eNO in heart failure (HF) patients has not been described. Previous studies have reported increased eNO levels after exercise in symptomatic HF patients but decreased levels with pulmonary arterial hypertension. Our objective was to prospectively examine the potential myocardial and functional determinants of exercise-induced rise of eNO in HF.Methods and ResultsThirty-four consecutive ambulatory patients with chronic systolic HF (left ventricular ejection fraction [LVEF] ≤45%) underwent symptom-limited cardiopulmonary stress testing and echocardiography. eNO was determined immediately after exercise. Systemic endothelial dysfunction was assessed by asymmetric dimethylarginine (ADMA) and the L-arginine/ADMA ratio. In our study cohort (mean age 53 ± 13 years, 76% male, median LVEF 31%, interquartile range [IQR] 25%–40%), the mean eNO was 23 ± 9 ppb. eNO levels were higher in patients with diastolic dysfunction stages 2 or 3 than stage 1 or normal diastology (26.1 ± 9 vs 19.5 ± 7 ppb; P = .013). eNO had a positive correlation with estimated systolic pulmonary artery pressure (r = 0.57; P = .0009) and indexed left atrium volume (r = 0.43; P = .014), but it did not correlate with cardiopulmonary exercise test parameters, ADMA, or symptom score.ConclusionsIn contrast to earlier reports, the increase in postexercise eNO observed in stable chronic systolic HF patients may be attributed to the presence of underlying pulmonary venous hypertension probably secondary to advanced diastolic dysfunction. |
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