Dietary nitrate supplementation and exercise tolerance in patients with heart failure with reduced ejection fraction

Dietary nitrate supplementation and exercise tolerance in patients with heart failure with reduced ejection fraction

Author Hirai, Daniel Müller Autor UNIFESP Google Scholar
Zelt, Joel T. Google Scholar
Jones, Joshua H. Google Scholar
Castanhas, Luiza G. Google Scholar
Bentley, Robert F. Google Scholar
Earle, Wendy Google Scholar
Staples, Patti Google Scholar
Tschakovsky, Michael E. Google Scholar
McCans, John Google Scholar
O'Donnell, Denis E. Google Scholar
Neder, J. Alberto Google Scholar
Abstract Endothelial dysfunction and reduced nitric oxide (NO) signaling are key abnormalities leading to skeletal muscle oxygen delivery-utilization mismatch and poor physical capacity in patients with heart failure with reduced ejection fraction (HFrEF). Oral inorganic nitrate supplementation provides an exogenous source of NO that may enhance locomotor muscle function and oxygenation with consequent improvement in exercise tolerance in HFrEF. Thirteen patients (left ventricular ejection fraction <= 40%) were enrolled in a double-blind, randomized crossover study to receive concentrated nitrate-rich (nitrate) or nitrate-depleted (placebo) beetroot juice for 9 days. Low- and high-intensity constant-load cardiopulmonary exercise tests were performed with noninvasive measurements of central hemodynamics (stroke volume, heart rate, and cardiac output via impedance cardiography), arterial blood pressure, pulmonary oxygen uptake, quadriceps muscle oxygenation (near-infrared spectroscopy), and blood lactate concentration. Ten patients completed the study with no adverse clinical effects. Nitrate-rich supplementation resulted in significantly higher plasma nitrite concentration compared with placebo (240 +/- 48 vs. 56 +/- 8 nM, respectively

P < 0.05). There was no significant difference in the primary outcome of time to exercise intolerance between nitrate and placebo (495 +/- 53 vs. 489 +/- 58 s, respectively

P > 0.05). Similarly, there were no significant differences in central hemodynamics, arterial blood pressure, pulmonary oxygen uptake kinetics, skeletal muscle oxygenation, or blood lactate concentration from rest to low- or high-intensity exercise between conditions. Oral inorganic nitrate supplementation with concentrated beetroot juice did not present with beneficial effects on central or peripheral components of the oxygen transport pathway thereby failing to improve exercise tolerance in patients with moderate HFrEF.
Keywords blood pressure
nitric oxide
oxygen consumption
skeletal muscle
xmlui.dri2xhtml.METS-1.0.item-coverage Bethesda
Language English
Sponsor Senate Advisory Research Committee (SARC) Postdoctoral Fellow Support Program
Department of Medicine, Queen's University
Date 2017
Published in American Journal Of Physiology-Regulatory Integrative And Comparative Physiology. Bethesda, v. 312, n. 1, p. R13-R22, 2017.
ISSN 0363-6119 (Sherpa/Romeo, impact factor)
Publisher Amer Physiological Soc
Extent R13-R22
Access rights Open access Open Access
Type Article
Web of Science ID WOS:000395715600003

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