Nitric oxide inhalation reduces pulmonary tidal volume during exercise in severe chronic heart failure☆,☆☆,★
Section snippets
Subjects
Fifteen patients (12 men and three women) with a mean age of 48 ± 12 years who had severe left ventricular dysfunction and chronic heart failure for >6 months were enrolled in this study. The mean left ventricular ejection fraction measured by radionuclide scintigraphy was 19% ± 5% and mean right ventricular ejection fraction was 20% ± 7%. Three patients were in New York Heart Association functional class II, 11 in functional class III, and one in functional class IV, despite full treatment
Rest
Mean resting values of heart rate, systolic systemic arterial pressure, diastolic systemic arterial pressure, estimated VD/VT, respiratory rate, VT, oxygen uptake, and VE/VO 2 were unchanged by nitric oxide inhalation (Table I). In contrast, there was a trend toward an increase in minute ventilation and oxygen uptake and a reduction in VE/VCO 2 with nitric oxide inhalation.
Peak exercise
From rest to maximum exercise in both control and nitric oxide inhalation conditions, an increase was observed in heart
Discussion
The attenuated increase in VT and pulmonary ventilation associated with a reduction in the VE/VCO 2 slope during nitric oxide inhalation testing suggests a non-CO 2 signal for control of VT, dependent on, mediated by, or influenced by nitric oxide inhalation in heart failure during exercise. It is believed that a non-CO 2 signal for ventilation is enhanced in heart failure based on a steeper VE/CO 2 slope dependent on the severity of heart failure with a correlation with peak VO 2 . 12
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