PDE5 Inhibition With Sildenafil Improves Left Ventricular Diastolic Function, Cardiac Geometry, and Clinical Status in Patients With Stable Systolic Heart Failure

Abstract

Background-In heart failure (HF), a defective nitric oxide signaling is involved in left ventricular (LV) diastolic abnormalities and remodeling. PDE5 inhibition, by blocking degradation of nitric oxide second-messenger cyclic guanosine monophosphate, might be beneficial. In a cohort of systolic HF patients, we tested the effects of PDE5 inhibition (sildenafil) on LV ejection fraction, diastolic function, cardiac geometry, and clinical status. Methods and Results-Forty-five HF patients (New York Heart Association class II-III) were randomly assigned to placebo or sildenafil (50 mg three times per day) for 1 year, with assessment (6 months and 1 year) of LV ejection fraction, diastolic function, geometry, cardiopulmonary exercise performance, and quality of life. In the sildenafil group only, at 6 months and 1 year, LV ejection fraction, early diastolic tissue Doppler velocities (EЈ) at the mitral lateral (from 4.62 to 5.20 and 5.19 m/s) and septal (from 4.71 to 5.23 and 5.24 m/s) annuli significantly increased, whereas the ratio of early transmitral (E) to EЈ lateral decreased (from 13.1 to 9.8 to 9.4) (PϽ0.01). Changes were accompanied by a reverse remodeling of left atrial volume index (from 32.0 to 29.0 and 29.1 mL/m

2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure

“…tiazydowe leki moczopędne, spironolakton i LBA) mogą zwiększać zaburzenia wzwodu [444,445]. Inhibitory fosfodiesterazy typu 5 (PDE5) mają korzystny wpływ na hemodynamikę i procesy remodelingu, poprawiają wydolność wysiłkową oraz jakość życia u pacjentów z HFrEF [446,447], jednak są przeciwwskazane u chorych przyjmujących azotany.…”

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“…(63) Its use in patients with heart failure is associated with improved left ventricular function, functional capacity, and quality of life in adults with systolic left ventricular dysfunction and secondary pulmonary hypertension.…”