The Effects of Inhaled Sodium Nitrite on Pulmonary Vascular Impedance in Patients With Pulmonary Hypertension Associated with Heart Failure With Preserved Ejection Fraction

Bashline, Michael; Bachman, Timothy N.; Helbling, Nicole L.; Nouraie, Mehdi; Gladwin, Mark T.; Simon, Marc A.

doi:10.1016/j.cardfail.2020.04.006

Cited by 11 publications

(5 citation statements)

References 33 publications

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“…Future versions will also facilitate variable Zc harmonics as high-fidelity wires become more accessible. Multiple potential clinical applications at advanced heart failure and pulmonary hypertension centers exist including drug studies [10] , exercise studies, and evaluation of surgical interventions.…”

Section: Discussionmentioning

confidence: 99%

Semi-Automated Graphical System for Calculating Pulmonary Vascular Impedances in a Clinical Setting

Bachman

Kim

Simon

2021

IEEE Open J. Eng. Med. Biol.

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Goal: Create a semi-automated, graphical, stand-alone application that uses clinically available asynchronous pressure and Doppler velocity captures to rapidly calculate, display, and interpret the pulmonary vascular impedance (PVZ) spectra. Methods: MATLAB-based software was written to analyze PVZ by creating a composite PVZ (cPVZ) spectra comprised of asynchronous screen captures of pulmonary arterial pressure and pulmonary arterial pulsed-wave Doppler velocity waveforms obtained during standard of care procedures. The pressure waveform, Doppler frequency envelopes, and ECG signals were re-digitized via automated border detection. cPVZ of averaged representative beats was calculated in the frequency domain via Fast Fourier Transform, and plotted vs harmonic z. Results: Successful generation of impedance spectra (PVZ(z)), where z is the harmonic, and additional parameters for characteristic impedance (Zc) and stiffness (Zs) were calculated as the mean of PVZ(2-4), and the sum of PVZ (1, 2), respectively. Conclusions: A graphically driven analysis of PVZ, calculated from standard of care right heart catheterization and echocardiography is possible. This system can help characterize both the steady and pulsatile components of right ventricular (RV) afterload in the clinical setting.

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Section: Discussionmentioning

confidence: 99%

Semi-Automated Graphical System for Calculating Pulmonary Vascular Impedances in a Clinical Setting

Bachman

Kim

Simon

2021

IEEE Open J. Eng. Med. Biol.

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“…Previous studies have shown the effect of inhaled or infused sodium nitrite in subjects with HFpEF ( Table 4 ). 50) 51) Inhaled sodium nitrite was shown to reduce PVR in patients with severe PH-LHD compared with controls. Infusion of sodium nitrite during invasive cardiac catheterization also significantly lowered PAWP and mPAP levels ( Table 4 ).…”

Section: Novel Therapies and Devices In Ph-lhdmentioning

confidence: 99%

Pulmonary Hypertension in Heart Failure

2021

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Pulmonary hypertension (PH) is traditionally defined as a mean pulmonary arterial pressure (mPAP) ≥25 mmHg. Although various factors cause PH, the most common etiology is PH due to left heart disease (PH-LHD). The underlying LHD is characterized by heart failure (HF) with reduced ejection fraction (HFrEF), HF with preserved ejection fraction (HFpEF), valvular heart disease, cardiomyopathies, or arrhythmic diseases. Regardless of its underlying cause, elevated left atrial (LA) filling pressure is a manifestation of advanced heart disease. High LA pressure then causes persistent backflow to the pulmonary veins, which increases mPAP. PH-LHD at this stage is named isolated postcapillary PH (IpcPH). Further progression of IpcPH is associated with pulmonary vasculature remodeling and hypertrophy, which consists of adding the precapillary component of PH to the pre-existing postcapillary PH. This form of PH-LHD is called combined precapillary and postcapillary PH (CpcPH). To date, therapeutic strategies for PH-LHD have been investigated in the context of HFrEF or HFpEF. Pulmonary arterial hypertension (PAH)-specific drugs have been tested in HFrEF and HFpEF populations, although encouraging results have not been demonstrated. As PAH-specific drugs target the precapillary component of PH-LHD, future studies utilizing such therapeutics in PH-LHD patients with CpcPH appear to have a more robust pathobiological basis. This article reviews the diagnosis, pathophysiology, treatment, and future direction of PH in HF.

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“…KNO 3 (aka saltpeter or niter) has been known to humans since prehistoric times and has been used in Chinese medicine since the 8 th century for treatment of angina ( Butler and Feelisch, 2008 ). Others have used NaNO 3 supplementation, intravenous infusions or inhaled NO 2 - in healthy volunteers or those with hypertension or heart failure with preserved ejection fraction ( Larsen et al, 2006 ; Borlaug et al, 2015 ; Bashline et al, 2020 ). To our knowledge, no formulations other than beetroot juice or KNO 3 have been used in studies of HF.…”

Section: Form Dose and Timing Of No 3 - ...mentioning

confidence: 99%

Skeletal Muscle Contractile Function in Heart Failure With Reduced Ejection Fraction—A Focus on Nitric Oxide

2022

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Despite advances over the past few decades, heart failure with reduced ejection fraction (HFrEF) remains not only a mortal but a disabling disease. Indeed, the New York Heart Association classification of HFrEF severity is based on how much exercise a patient can perform. Moreover, exercise capacity—both aerobic exercise performance and muscle power—are intimately linked with survival in patients with HFrEF. This review will highlight the pathologic changes in skeletal muscle in HFrEF that are related to impaired exercise performance. Next, it will discuss the key role that impaired nitric oxide (NO) bioavailability plays in HFrEF skeletal muscle pathology. Lastly, it will discuss intriguing new data suggesting that the inorganic nitrate ‘enterosalivary pathway’ may be leveraged to increase NO bioavailability via ingestion of inorganic nitrate. This ingestion of inorganic nitrate has several advantages over organic nitrate (e.g., nitroglycerin) and the endogenous nitric oxide synthase pathway. Moreover, inorganic nitrate has been shown to improve exercise performance: both muscle power and aerobic capacity, in some recent small but well-controlled, cross-over studies in patients with HFrEF. Given the critical importance of better exercise performance for the amelioration of disability as well as its links with improved outcomes in patients with HFrEF, further studies of inorganic nitrate as a potential novel treatment is critical.

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The Effects of Inhaled Sodium Nitrite on Pulmonary Vascular Impedance in Patients With Pulmonary Hypertension Associated with Heart Failure With Preserved Ejection Fraction

Cited by 11 publications

References 33 publications

Semi-Automated Graphical System for Calculating Pulmonary Vascular Impedances in a Clinical Setting

Semi-Automated Graphical System for Calculating Pulmonary Vascular Impedances in a Clinical Setting

Pulmonary Hypertension in Heart Failure

Skeletal Muscle Contractile Function in Heart Failure With Reduced Ejection Fraction—A Focus on Nitric Oxide

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