Long-Term Use of Sildenafil in the Therapeutic Management of Heart Failure

Abstract

In CHF, improvement in exercise ventilation and aerobic efficiency with sildenafil is sustained and is significantly related with an endothelium-mediated attenuation of exercising muscle oversignaling. Chronic sildenafil seems to be a remedy based on CHF pathophysiology and devoid of remarkable adverse effects.

Fluido torácico total – Um possível determinante da eficácia ventilatória em doentes com insuficiência cardíaca

“…O «ergoreflexo», que estará aumentado nestes doentes, é um complexo refl exo metabólico pelo qual quimioreceptores dos músculos periféricos, sensíveis a bioprodutos metabólicos locais produzidos durante o exercício, iniciam um refl exo neuronal que leva à hiperventilação 5 . Embora ainda esteja por defi nir com precisão a contribuição relativa do ergorefl exo para a ventilação excessiva, Guazzi et al 16 demonstraram que a administração a longo prazo de sildenafi l em doentes com ICC leva a uma atenuação deste refl exo e a uma melhoria do dVE/VCO 2 .…”

Hypertension and heart failure: a dysfunction of systole, diastole or both?

“…111 Further investigation of treatments to enhance vasodilator reserve and their effectiveness in this population is also warranted. [121][122][123][124][125] In summary, HHD with heart failure is simply not a dysfunction of systole or diastole alone but to some extent involves both. In addition, other peripheral factors including heart rate, arterial compliance and vasodilator response with exercise deserve equal attention in an attempt to develop more effective treatments and prevention strategies.…”

Pulmonary Hypertension in Heart Failure Preserved Ejection Fraction

“…These studies may challenge this scenario based on some At variance with other pulmonary vasodilators, evidence is accumulating that inhibition of phosphodiesterase-5 (PDE5), the isoenzyme that breaks down cGMP to its inactive form, may be an effective and well-tolerated tool for targeting the pulmonary vasculature and unloading the RV in left-sided PH. 53 This is suggested by multiple observations made in patients with left-sided PH of various pathogenesis and severity, with acute [54][55][56][57] and long-term administration [58][59][60][61] of sildenafil. Intriguingly, the benefits of PDE5 inhibitors compared with other classes of pulmonary vasodilators stand on the pulmonary vascular selectivity of PDE5 expression in lung microvessels both in physiological and, even more, pathological conditions, avoiding the untoward systemic hypotensive effect that is typical of other pulmonary vasodilating agents, such as prostanoids and ERAs.…”