title: Acute Dietary Nitrate Intake Improves Muscle Contractile Function in Patients With Heart Failure: A Double-Blind, Placebo-Controlled, Randomized Trial.
abstract: BACKGROUND
  Skeletal muscle strength, velocity, and power are markedly reduced in patients with heart failure, which contributes to their impaired exercise capacity and lower quality of life. This muscle dysfunction may be partially because of decreased nitric oxide (NO) bioavailability. We therefore sought to determine whether ingestion of inorganic nitrate (NO3 (-)) would increase NO production and improve muscle function in patients with heart failure because of systolic dysfunction.
  
  
  RESULTS
  Using a double-blind, placebo-controlled, randomized crossover design, we determined the effects of dietary NO3 (-) in 9 patients with heart failure. After fasting overnight, subjects drank beetroot juice containing or devoid of 11.2 mmol of NO3 (-). Two hours later, muscle function was assessed using isokinetic dynamometry. Dietary NO3 (-) increased (P<0.05-0.001) breath NO by 35% to 50%. This was accompanied by 9% (P=0.07) and 11% (P<0.05) increases in peak knee extensor power at the 2 highest movement velocities tested (ie, 4.71 and 6.28 rad/s). Maximal power (calculated by fitting peak power data with a parabola) was therefore greater (ie, 4.74±0.41 versus 4.20±0.33 W/kg; P<0.05) after dietary NO3 (-) intake. Calculated maximal velocity of knee extension was also higher after NO3 (-) ingestion (ie, 12.48±0.95 versus 11.11±0.53 rad/s; P<0.05). Blood pressure was unchanged, and no adverse clinical events occurred.
  
  
  CONCLUSIONS
  In this pilot study, acute dietary NO3 (-) intake was well tolerated and enhanced NO bioavailability and muscle power in patients with systolic heart failure. Larger-scale studies should be conducted to determine whether the latter translates into an improved quality of life in this population.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT01682356.
authors.affiliation: From the Cardiovascular Imaging Laboratory, Division of Radiological Sciences, Department of Radiology (A.R.C., J.L.L., L.R.P.), Cardiovascular Division, Department of Medicine (J.L.L., A.K., D.P.T., S.R., K.M., S.P., M.F., L.R.P.), and Center for Applied Research Sciences (C.A.S.), Washington University School of Medicine, St. Louis, MO. coggana@mir.wustl.edu.
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Coggan
authors.affiliation: From the Cardiovascular Imaging Laboratory, Division of Radiological Sciences, Department of Radiology (A.R.C., J.L.L., L.R.P.), Cardiovascular Division, Department of Medicine (J.L.L., A.K., D.P.T., S.R., K.M., S.P., M.F., L.R.P.), and Center for Applied Research Sciences (C.A.S.), Washington University School of Medicine, St. Louis, MO.
authors.forename: Joshua L
authors.initials: JL
authors.lastname: Leibowitz
authors.affiliation: From the Cardiovascular Imaging Laboratory, Division of Radiological Sciences, Department of Radiology (A.R.C., J.L.L., L.R.P.), Cardiovascular Division, Department of Medicine (J.L.L., A.K., D.P.T., S.R., K.M., S.P., M.F., L.R.P.), and Center for Applied Research Sciences (C.A.S.), Washington University School of Medicine, St. Louis, MO.
authors.forename: Catherine Anderson
authors.initials: CA
authors.lastname: Spearie
authors.affiliation: From the Cardiovascular Imaging Laboratory, Division of Radiological Sciences, Department of Radiology (A.R.C., J.L.L., L.R.P.), Cardiovascular Division, Department of Medicine (J.L.L., A.K., D.P.T., S.R., K.M., S.P., M.F., L.R.P.), and Center for Applied Research Sciences (C.A.S.), Washington University School of Medicine, St. Louis, MO.
authors.forename: Ana
authors.initials: A
authors.lastname: Kadkhodayan
authors.affiliation: From the Cardiovascular Imaging Laboratory, Division of Radiological Sciences, Department of Radiology (A.R.C., J.L.L., L.R.P.), Cardiovascular Division, Department of Medicine (J.L.L., A.K., D.P.T., S.R., K.M., S.P., M.F., L.R.P.), and Center for Applied Research Sciences (C.A.S.), Washington University School of Medicine, St. Louis, MO.
authors.forename: Deepak P
authors.initials: DP
authors.lastname: Thomas
authors.affiliation: From the Cardiovascular Imaging Laboratory, Division of Radiological Sciences, Department of Radiology (A.R.C., J.L.L., L.R.P.), Cardiovascular Division, Department of Medicine (J.L.L., A.K., D.P.T., S.R., K.M., S.P., M.F., L.R.P.), and Center for Applied Research Sciences (C.A.S.), Washington University School of Medicine, St. Louis, MO.
authors.forename: Sujata
authors.initials: S
authors.lastname: Ramamurthy
authors.affiliation: From the Cardiovascular Imaging Laboratory, Division of Radiological Sciences, Department of Radiology (A.R.C., J.L.L., L.R.P.), Cardiovascular Division, Department of Medicine (J.L.L., A.K., D.P.T., S.R., K.M., S.P., M.F., L.R.P.), and Center for Applied Research Sciences (C.A.S.), Washington University School of Medicine, St. Louis, MO.
authors.forename: Kiran
authors.initials: K
authors.lastname: Mahmood
authors.affiliation: From the Cardiovascular Imaging Laboratory, Division of Radiological Sciences, Department of Radiology (A.R.C., J.L.L., L.R.P.), Cardiovascular Division, Department of Medicine (J.L.L., A.K., D.P.T., S.R., K.M., S.P., M.F., L.R.P.), and Center for Applied Research Sciences (C.A.S.), Washington University School of Medicine, St. Louis, MO.
authors.forename: Soo
authors.initials: S
authors.lastname: Park
authors.affiliation: From the Cardiovascular Imaging Laboratory, Division of Radiological Sciences, Department of Radiology (A.R.C., J.L.L., L.R.P.), Cardiovascular Division, Department of Medicine (J.L.L., A.K., D.P.T., S.R., K.M., S.P., M.F., L.R.P.), and Center for Applied Research Sciences (C.A.S.), Washington University School of Medicine, St. Louis, MO.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Waller
authors.affiliation: From the Cardiovascular Imaging Laboratory, Division of Radiological Sciences, Department of Radiology (A.R.C., J.L.L., L.R.P.), Cardiovascular Division, Department of Medicine (J.L.L., A.K., D.P.T., S.R., K.M., S.P., M.F., L.R.P.), and Center for Applied Research Sciences (C.A.S.), Washington University School of Medicine, St. Louis, MO.
authors.forename: Marsha
authors.initials: M
authors.lastname: Farmer
authors.affiliation: From the Cardiovascular Imaging Laboratory, Division of Radiological Sciences, Department of Radiology (A.R.C., J.L.L., L.R.P.), Cardiovascular Division, Department of Medicine (J.L.L., A.K., D.P.T., S.R., K.M., S.P., M.F., L.R.P.), and Center for Applied Research Sciences (C.A.S.), Washington University School of Medicine, St. Louis, MO.
authors.forename: Linda R
authors.initials: LR
authors.lastname: Peterson
mesh_terms: D018592:Cross-Over Studies; D019587:Dietary Supplements; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D015444:Exercise / Q000502:physiology*; D005260:Female; D006333:Heart Failure / Q000178:diet therapy* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009119:Muscle Contraction / Q000187:drug effects*; D018482:Muscle, Skeletal / Q000187:drug effects / Q000503:physiopathology*; D009566:Nitrates / Q000008:administration & dosage*; D010101:Oxygen Consumption; D010865:Pilot Projects; D011788:Quality of Life
chemical_list: D009566:Nitrates
keywords: heart failure; muscle contraction; muscle strength; nitrates; nitric oxide; nutrition theory; quality of life