Abstract

Introduction

Materials & Methods

Results

Discussion & Conclusion

References

Discussion
Board

Nitrates are not formally approved for the treatment of chronic heart failure (CHF). However, information from large-scale trials (1,2) confirms that these agents are widely used in patients with CHF in a combination with other drugs. The beneficial effects of nitrate therapy are attributable to the physiologic consequences of vasodilation and antiplatelet action (3). An anti-remodeling effect of nitrates has also been demonstrated in animals and humans (4).

The main benefit of nitrates in chronic heart failure is a prominent reduction of left ventricular (LV) filling pressure. This effect of nitrates has led to their recommendation for use in patients with an elevated filling pressure that is not responding adequately to diuretic therapy. However, nitrate therapy may have a harmful effect on cardiac output in patients with CHF when LV filling pressure is markedly reduced (5).

Several studies have recently demonstrated that a restrictive pattern of LV filling, characterized by predominant early filling with a short deceleration time and short isovolumic relaxation time is associated with high LV filling pressure (6,7). Patients with restrictive filling have more severe symptoms of CHF (8-10) and reduced exercise capacity (11). The restrictive filling pattern is a poor prognostic indicator in patients with CHF of different origin (8,12-14). It has also been found that the evolution of LV filling pattern has an additional prognostic value (14). There are data that acute unloading interventions leading to a reduction in filling pressure are capable to reverse a restrictive pattern to a nonrestrictive pattern (15,16).

This study was designed to determine whether long-term nitrate administration, in conjunction with standard therapy, affects the restrictive pattern of LV diastolic filling in patients with CHF. Effects of therapy on clinical, echocardiographic and Doppler-derived parameters were also investigated.

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