title: Effect of acute nitrate ingestion on central hemodynamic load in hypoxia.
abstract: Acute hypoxia results in local vasodilation that may temporarily unload the left ventricle (LV) through nitric oxide (NO)-mediated mechanisms. Whether increasing NO levels augments LV unloading and improves ventricular-vascular coupling in hypoxia remains unknown.
  
  
  OBJECTIVE
  Investigate the effect of acute nitrate ingestion on central hemodynamic load in hypoxia.
  
  
  METHODS
  20 Healthy men (23 ± 3 yrs, BMI 24.6 ± 2.8 kg m(-2)) consumed 70 mL of either a) 0.45 g nitrate (NIT) or b) an inert placebo (PLA) prior to 105 min of normobaric hypoxia (11.6 ± 0.1%) in this randomized, double-blind, crossover-design study. Wave reflection index (RIX; ratio of forward to reflected wave pressure), augmentation index (AIX75) and pulse wave velocity were calculated as measures of wave reflection magnitude and aortic stiffness, respectively, from the aortic blood pressure (BP) waveform. LV wasted pressure effort (WPE) was calculated as an index of LV work due to wave reflections. Subendocardial viability ratio (SEVR) was assessed a measure of myocardial O2 supply/demand ratio.
  
  
  RESULTS
  Aortic diastolic BP decreased in hypoxia compared to normoxia (p < 0.05). Aortic RIX, AIX75, and LV WPE significantly decreased in hypoxia compared to normoxia (p < 0.05). Aortic systolic BP, SEVR, and PWV were unaffected by hypoxia (p > 0.05). Compared to placebo, nitrate ingestion did not significantly alter central hemodynamics in hypoxia (p > 0.05).
  
  
  CONCLUSIONS
  Acute hypoxic exposure unloads the LV (WPE, AIX75, and RIX) without disturbing myocardial O2 supply-demand ratio (SEVR). Reductions in LV work with hypoxia are likely due to reductions in pressure from wave reflections as hypoxia had negligible effects on aortic stiffness. Nitrate ingestion did not affect the central hemodynamic response to acute systemic hypoxia.
authors.affiliation: Syracuse University, Syracuse, NY 13244, USA. Electronic address: wleffert@syr.edu.
authors.forename: Wesley K
authors.initials: WK
authors.lastname: Lefferts
authors.affiliation: Syracuse University, Syracuse, NY 13244, USA.
authors.forename: William E
authors.initials: WE
authors.lastname: Hughes
authors.affiliation: Syracuse University, Syracuse, NY 13244, USA.
authors.forename: Kevin S
authors.initials: KS
authors.lastname: Heffernan
mesh_terms: D000284:Administration, Oral; D000328:Adult; D062186:Arterial Pressure / Q000187:drug effects; D018592:Cross-Over Studies; D004311:Double-Blind Method; D006352:Heart Ventricles / Q000187:drug effects*; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D000860:Hypoxia / Q000378:metabolism*; D008297:Male; D009566:Nitrates / Q000008:administration & dosage* / Q000494:pharmacology*; D016277:Ventricular Function, Left / Q000187:drug effects*; D055815:Young Adult
chemical_list: D009566:Nitrates
keywords: Aortic blood pressure; Hypoxia; Nitrate; Wave reflections; Wave separation analysis