L‐Arginine reduces heart rate and improves hemodynamics in severe congestive heart failure
Open accessAbstract
Background: Stimulated endothelium‐derived relaxing factor‐mediated vasodilation and conduit artery distensibility are impaired in congestive heart failure (CHF). L‐arginine could have a potentially beneficial role in CHF, acting through the nitric oxide (NO)‐L‐arginine pathway or by growth hormone increment. Hypothesis: This study was undertaken to investigate the effects of L‐arginine on heart rate, hemodynamics, and left ventricular (LV) function in CHF. Methods: In seven patients (aged 39 ± 8 years) with CHF, we obtained the following parameters using echocardiography and an LV Millar Mikro‐Tip catheter simultaneously under four conditions: basal, during NO inhalation (40 ppm), in basal condition before L‐arginine infusion, and after L‐arginine intravenous infusion (mean dose 30.4 ± 1.9 g). Results: Nitric oxide inhalation increased pulmonary capillary wedge pressure from 25 ± 9 to 31 ± 7 mmHg (p < 0.05), but did not change echocardiographic variables or LV contractility by elastance determination. L‐arginine decreased heart rate (from 88 ± 15 to 80 ± 16 beats/min, p < 0.005), mean systemic arterial pressure (from 84 ± 17 to 70 ± 18 mmHg, p < 0.007), and systemic vascular resistance (from 24 ± 8 to 15 ± 6 Wood units, p < 0.003). L‐arginine increased right atrial pressure (from 7 ± 2 to 10 ± 3 mmHg, p < 0.04), cardiac output (from 3.4 ± 0.7 to 4.1 ± 0.8 l/min, p < 0.009), and stroke volume (from 40 ± 9 to 54 ± 14 ml, p < 0.008). The ratios of pulmonary vascular resistance to systemic vascular resistance at baseline and during NO inhalation were 0.09 and 0.075, respectively, and with L‐arginine this increased from 0.09 to 0.12. Conclusion: L‐arginine exerted no effect on contractility; however, by acting on systemic vascular resistance it improved cardiac performance. L‐arginine showed a negative chronotropic effect. The possible beneficial effect of L‐arginine on reversing endothelial dysfunction in CHF without changing LV contractility should be the subject of further investigations.
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Similar observations following arginine supplementation in heart failure patients implicate the production of exogenous NO in the reduction of systemic vascular resistance.
“Similar observations have been made following arginine supplementation in HF patients implicating the production of exogenous NO in the reduction of systemic vascular resistance (Bocchi et al. 2000).”
From Oral nitrate and citrulline decrease blood pressure and increase vascular conductance in young adults: a potential therapy for heart failure (2016) · cites this paper as Bocchi et al. 2000
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Sorted by citations
Alsop, P., & Hauton, D. (2016) · European Journal of Applied Physiology · doi:10.1007/s00421-016-3418-7 · Cited by 37 · see citing works
- Authors
- Bocchi, E. A., De Moraes, A. V., Esteves‐Filho, A., Bacal, F., Auler, J. O., Carmona, M. J., Bellotti, G., & Ramires, A. F.
- Affiliations
- Universidade de São Paulo (BR)
- Corresponding author
- Bocchi, Edimar Alcides
- Venue
- Clinical Cardiology
- Publisher
- Wiley
- Published
- 2000-03
- Volume
- 23
- Issue
- 3
- Pages
- 205-210
- ISSN
- 0160-9289 (ISSN-L)
- 1932-8737
- PMC
- PMC6654780
- OpenAlex
- W2087210760
- Cited by
- 45
- References
- 43
- Citations by year
- 2025: 2 · 2024: 1 · 2022: 1 · 2021: 3 · 2020: 1 · 2019: 3 · 2017: 3 · 2016: 4 · 2014: 1 · 2013: 1 · 2012: 3
- FWCI
- 1.98
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Clinical Cardiology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Physiology › Nitric Oxide and Endothelin Effects
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Keywords
- L-arginine, congestive heart failure, heart rate, hemodynamics, nitric oxide, inhaled nitric oxide, systemic vascular resistance, left ventricular function, cardiac output, stroke volume, pulmonary capillary wedge pressure, right atrial pressure, chronotropic effect, nitric oxide synthase, endothelium-derived relaxing factor, vasodilation, growth hormone
- MeSH terms
- Adult, Arginine, Endothelium, Vascular, Heart Failure, Heart Rate, Hemodynamics, Humans, Infusions, Intravenous, Middle Aged, Nitric Oxide, Vascular Resistance, Vasodilator Agents, Ventricular Dysfunction, Left
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