title: Low-dose nitroglycerin improves microcirculation in hospitalized patients with acute heart failure.
abstract: OBJECTIVE
  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.
  
  
  RESULTS
  In 20 acute heart failure patients, NTG was given as intravenous infusion at a fixed dose of 33 microg/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 microm. 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).
  
  
  CONCLUSIONS
  Low-dose NTG significantly reduces cardiac filling pressures and improves microvascular perfusion in patients admitted for acute heart failure.
authors.affiliation: Erasmus Medical Center, Department of Cardiology and Intensive Care, NL-3015 CE Rotterdam, The Netherlands. c.denuil@erasmusmc.nl
authors.forename: Corstiaan A
authors.initials: CA
authors.lastname: den Uil
authors.forename: Wim K
authors.initials: WK
authors.lastname: Lagrand
authors.forename: Peter E
authors.initials: PE
authors.lastname: Spronk
authors.forename: Martin
authors.initials: M
authors.lastname: van der Ent
authors.forename: Lucia S D
authors.initials: LS
authors.lastname: Jewbali
authors.forename: Jasper J
authors.initials: JJ
authors.lastname: Brugts
authors.forename: Can
authors.initials: C
authors.lastname: Ince
authors.forename: Maarten L
authors.initials: ML
authors.lastname: Simoons
mesh_terms: D000208:Acute Disease; D000368:Aged; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D007262:Infusions, Intravenous; D007297:Inpatients; D008297:Male; D008833:Microcirculation / Q000187:drug effects / Q000502:physiology*; D008875:Middle Aged; D005996:Nitroglycerin / Q000008:administration & dosage*; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage*; D017725:Ventricular Pressure / Q000187:drug effects / Q000502:physiology
chemical_list: D014665:Vasodilator Agents; D005996:Nitroglycerin