den Uil Corstiaan A, Lagrand Wim K, Spronk Peter E, van der Ent Martin, Jewbali Lucia S D, Brugts Jasper J, Ince Can, Simoons Maarten L
Erasmus Medical Center, Department of Cardiology and Intensive Care, NL-3015 CE Rotterdam, The Netherlands.
Eur J Heart Fail. 2009 Apr;11(4):386-90. doi: 10.1093/eurjhf/hfp021. Epub 2009 Feb 10.
Impaired tissue perfusion is often observed in patients with acute heart failure. We tested whether low-dose nitroglycerin (NTG) improves microcirculatory perfusion in patients admitted for acute heart failure.
In 20 acute heart failure patients, NTG was given as intravenous infusion at a fixed dose of 33 microg/min. Using Sidestream Dark Field (SDF) imaging, sublingual microvascular perfusion was evaluated before (T0, average of two baseline measurements) and 15 min after initiation of NTG (T1). In a subgroup of seven patients, SDF measurements were repeated after NTG had been stopped for 20 min. Capillaries were defined as microvessels with a diameter of <20 microm. Perfused capillary density (PCD) was determined as the parameter of tissue perfusion. Values are expressed as median and interquartile range (P25; P75). The median age of the subjects was 60 (52; 73) years, and 65% were male. Patients were stable before starting NTG. Nitroglycerin decreased central venous pressure [17 (13; 19) mmHg at T0 vs. 16 (13; 17) mmHg at T1, P = 0.03] and pulmonary capillary wedge pressure [23 (18; 31) mmHg at T0 vs. 19 (16; 25) mmHg at T1, P = 0.03]. It increased PCD [10.7 (9.9; 12.5) mm mm(-2) at T0 vs. 12.4 (11.4; 13.6) mm mm(-2) at T1, P = 0.01]. After cessation of NTG, PCD returned to baseline values (P = 0.04).
Low-dose NTG significantly reduces cardiac filling pressures and improves microvascular perfusion in patients admitted for acute heart failure.
急性心力衰竭患者常出现组织灌注受损。我们测试了低剂量硝酸甘油（NTG）是否能改善因急性心力衰竭入院患者的微循环灌注。
在20例急性心力衰竭患者中，以33微克/分钟的固定剂量静脉输注NTG。使用侧流暗视野（SDF）成像，在NTG开始前（T0，两次基线测量的平均值）和开始后15分钟（T1）评估舌下微血管灌注。在7例患者的亚组中，NTG停止20分钟后重复进行SDF测量。将直径<20微米的微血管定义为毛细血管。灌注毛细血管密度（PCD）被确定为组织灌注的参数。数值以中位数和四分位数间距（P25；P75）表示。受试者的中位年龄为60（52；73）岁，65%为男性。患者在开始使用NTG前病情稳定。硝酸甘油降低了中心静脉压[T0时为17（13；19）mmHg，T1时为16（13；17）mmHg，P = 0.03]和肺毛细血管楔压[T0时为23（18；31）mmHg，T1时为19（16；25）mmHg，P = 0.03]。它增加了PCD[T0时为10.7（9.9；12.5）毫米/毫米²，T1时为12.4（11.4；13.6）毫米/毫米²，P = 0.01]。NTG停止后，PCD恢复到基线值（P = 0.04）。
低剂量NTG可显著降低急性心力衰竭入院患者的心脏充盈压并改善微血管灌注。
