AimsImpaired 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.Methods and resultsIn 20 acute heart failure patients, NTG was given as intravenous infusion at a fixed dose of 33 g/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 m. 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-2at T0 vs. 12.4 (11.4; 13.6) mm mm-2at T1, P = 0.01]. After cessation of NTG, PCD returned to baseline values (P = 0.04).ConclusionLow-dose NTG significantly reduces cardiac filling pressures and improves microvascular perfusion in patients admitted for acute heart failure.

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Keywords Acute heart failure, Microcirculation, Nitroglycerin, Perfusion, Side-stream dark field imaging
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den Uil, C.A, Lagrand, W.K, Spronk, P.E, van der Ent, M, Jewbali, L.S.D, Brugts, J.J, … Simoons, M.L. (2009). Low-dose nitroglycerin improves microcirculation in hospitalized patients with acute heart failure. European Journal of Heart Failure, 11(4), 386–390. doi:10.1093/eurjhf/hfp021