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Heart Failure, Left Ventricular Remodeling, and Circulating Nitric Oxide Metabolites

View Article: PubMed Central - PubMed

ABSTRACT

Background: Stable plasma nitric oxide (NO) metabolites (NOM), composed predominantly of nitrate and nitrite, are attractive biomarkers of NO bioavailability. NOM levels integrate the influence of NO‐synthase‐derived NO production/metabolism, dietary intake of inorganic nitrate/nitrite, and clearance of NOM. Furthermore, nitrate and nitrite, the most abundant NOM, can be reduced to NO via the nitrate‐nitrite‐NO pathway.

Methods and results: We compared serum NOM among subjects without heart failure (n=126), subjects with heart failure and preserved ejection fraction (HFpEF; n=43), and subjects with heart failure and reduced ejection fraction (HFrEF; n=32). LV mass and extracellular volume fraction were measured with cardiac MRI. Plasma NOM levels were measured after reduction to NO via reaction with vanadium (III)/hydrochloric acid. Subjects with HFpEF demonstrated significantly lower unadjusted levels of NOM (8.0 μmol/L; 95% CI 6.2–10.4 μmol/L; ANOVA P=0.013) than subjects without HF (12.0 μmol/L; 95% CI 10.4–13.9 μmol/L) or those with HFrEF (13.5 μmol/L; 95% CI 9.7–18.9 μmol/L). There were no significant differences in NOM between subjects with HFrEF and subjects without HF. In a multivariable model that adjusted for age, sex, race, diabetes mellitus, body mass index, current smoking, systolic blood pressure, and glomerular filtration rate, HFpEF remained a predictor of lower NOM (β=−0.43; P=0.013). NOM did not correlate with LV mass, or LV diffuse fibrosis.

Conclusions: HFpEF, but not HFrEF, is associated with reduced plasma NOM, suggesting greater endothelial dysfunction, enhanced clearance, or deficient dietary ingestion of inorganic nitrate. Our findings may underlie the salutary effects of inorganic nitrate supplementation demonstrated in recent clinical trials in HFpEF.

No MeSH data available.


Comparison of metabolites (NOM) levels between subjects without HF, subjects with heart failure and preserved ejection fraction (HFpEF) and subjects with heart failure and reduced ejection fraction (HFrEF).
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jah31828-fig-0002: Comparison of metabolites (NOM) levels between subjects without HF, subjects with heart failure and preserved ejection fraction (HFpEF) and subjects with heart failure and reduced ejection fraction (HFrEF).

Mentions: NOM levels in subjects without HF versus those with HFrEF and HFpEF are shown in Figure 2. There was a significant difference between the groups (ANOVA P=0.013). Post‐hoc pairwise comparisons revealed that subjects with HFpEF exhibited significantly lower levels of NOM (8.0 μmol/L; 95% CI 6.2‐10.4 μmol/L) compared to (12.0 μmol/L; 95% CI 10.4‐13.9 μmol/L; P=0.025) or to those with HFrEF (13.5 μmol/L; 95% CI 9.7‐18.9 μmol/L; P=0.03). There were no significant differences in NOM between subjects with HFrEF and subjects without HF (P=1.00).


Heart Failure, Left Ventricular Remodeling, and Circulating Nitric Oxide Metabolites
Comparison of metabolites (NOM) levels between subjects without HF, subjects with heart failure and preserved ejection fraction (HFpEF) and subjects with heart failure and reduced ejection fraction (HFrEF).
© Copyright Policy - creativeCommonsBy-nc
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5121510&req=5

jah31828-fig-0002: Comparison of metabolites (NOM) levels between subjects without HF, subjects with heart failure and preserved ejection fraction (HFpEF) and subjects with heart failure and reduced ejection fraction (HFrEF).
Mentions: NOM levels in subjects without HF versus those with HFrEF and HFpEF are shown in Figure 2. There was a significant difference between the groups (ANOVA P=0.013). Post‐hoc pairwise comparisons revealed that subjects with HFpEF exhibited significantly lower levels of NOM (8.0 μmol/L; 95% CI 6.2‐10.4 μmol/L) compared to (12.0 μmol/L; 95% CI 10.4‐13.9 μmol/L; P=0.025) or to those with HFrEF (13.5 μmol/L; 95% CI 9.7‐18.9 μmol/L; P=0.03). There were no significant differences in NOM between subjects with HFrEF and subjects without HF (P=1.00).

View Article: PubMed Central - PubMed

ABSTRACT

Background: Stable plasma nitric oxide (NO) metabolites (NOM), composed predominantly of nitrate and nitrite, are attractive biomarkers of NO bioavailability. NOM levels integrate the influence of NO‐synthase‐derived NO production/metabolism, dietary intake of inorganic nitrate/nitrite, and clearance of NOM. Furthermore, nitrate and nitrite, the most abundant NOM, can be reduced to NO via the nitrate‐nitrite‐NO pathway.

Methods and results: We compared serum NOM among subjects without heart failure (n=126), subjects with heart failure and preserved ejection fraction (HFpEF; n=43), and subjects with heart failure and reduced ejection fraction (HFrEF; n=32). LV mass and extracellular volume fraction were measured with cardiac MRI. Plasma NOM levels were measured after reduction to NO via reaction with vanadium (III)/hydrochloric acid. Subjects with HFpEF demonstrated significantly lower unadjusted levels of NOM (8.0 μmol/L; 95% CI 6.2–10.4 μmol/L; ANOVA P=0.013) than subjects without HF (12.0 μmol/L; 95% CI 10.4–13.9 μmol/L) or those with HFrEF (13.5 μmol/L; 95% CI 9.7–18.9 μmol/L). There were no significant differences in NOM between subjects with HFrEF and subjects without HF. In a multivariable model that adjusted for age, sex, race, diabetes mellitus, body mass index, current smoking, systolic blood pressure, and glomerular filtration rate, HFpEF remained a predictor of lower NOM (β=−0.43; P=0.013). NOM did not correlate with LV mass, or LV diffuse fibrosis.

Conclusions: HFpEF, but not HFrEF, is associated with reduced plasma NOM, suggesting greater endothelial dysfunction, enhanced clearance, or deficient dietary ingestion of inorganic nitrate. Our findings may underlie the salutary effects of inorganic nitrate supplementation demonstrated in recent clinical trials in HFpEF.

No MeSH data available.