Display options
Cite
Okamoto LE, Dupont WD, Biaggioni I, et al. Effect of nitroglycerin on splanchnic and pulmonary blood volume. J Nucl Cardiol. 2021;doi: 10.1007/s12350-021-02811-7.
Okamoto, L. E., Dupont, W. D., Biaggioni, I., & Kronenberg, M. W. (2021). Effect of nitroglycerin on splanchnic and pulmonary blood volume. Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology, . https://doi.org/10.1007/s12350-021-02811-7
Okamoto, Luis E, et al. "Effect of nitroglycerin on splanchnic and pulmonary blood volume." Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology vol. (2021). doi: https://doi.org/10.1007/s12350-021-02811-7
Okamoto LE, Dupont WD, Biaggioni I, Kronenberg MW. Effect of nitroglycerin on splanchnic and pulmonary blood volume. J Nucl Cardiol. 2021 Nov 02; doi: 10.1007/s12350-021-02811-7. Epub 2021 Nov 02. PMID: 34729682.
Copy Download .nbib Format: NLM
Share it on

J Nucl Cardiol. 2021 Nov 02; doi: 10.1007/s12350-021-02811-7. Epub 2021 Nov 02.

Effect of nitroglycerin on splanchnic and pulmonary blood volume.

Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology

Luis E Okamoto, William D Dupont, Italo Biaggioni, Marvin W Kronenberg

Affiliations

  1. Division of Clinical Pharmacology, Vanderbilt University School of Medicine, Nashville, TN, USA.
  2. The Vanderbilt Autonomic Dysfunction Center, Vanderbilt University School of Medicine, Nashville, TN, USA.
  3. Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.
  4. Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA.
  5. Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN, USA.
  6. Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA. [email protected].
  7. Division of Cardiovascular Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA. [email protected].
  8. Vanderbilt Heart and Vascular Institute, Vanderbilt Medical Center, East, Ste. 5209, 1215 21st. Ave, South, Nashville, TN, 37232, USA. [email protected].

PMID: 34729682 DOI: 10.1007/s12350-021-02811-7

Abstract

BACKGROUND: Sublingual nitroglycerin (SL NTG) is useful for treating acute decompensated heart failure, possibly by increasing splanchnic capacitance and reducing left ventricular (LV) preload. We evaluated a radionuclide method to study these effects, initially in subjects without heart failure.

METHODS AND RESULTS: Red blood cells were labelled by an in vitro method. Abdominal and chest images were obtained at rest, showing relative regional blood volumes. The abdomen was then re-imaged during progressive escalation of intrathoracic pressure using continuous positive airway pressure to assess baseline splanchnic capacitance (pressure-volume relationship, PVR) and compliance (slope of PVR). The procedure was repeated after 0.6 mg SL NTG, followed by chest images. Relative splanchnic blood volume increased at rest after SL NTG (P < .002), signifying an increase in splanchnic capacitance. The slope of the splanchnic PVR decreased in proportion to the baseline PVR (P = .0014), signifying increased compliance. The relative pulmonary blood volume decreased in proportion to the increase in splanchnic blood volume (P = .01).

CONCLUSIONS: A semi-quantitative radionuclide method demonstrated the effect of SL NTG for increasing splanchnic capacitance and compliance, with a proportional decrease in pulmonary blood volume. These data may be applied to quantitatively evaluate the importance of splanchnic vasodilation as a mechanism of LV preload reduction in the treatment of heart failure.

CLINICAL TRIALS REGISTRATION: NCT02425566.

© 2021. American Society of Nuclear Cardiology.

Keywords: Splanchnic scintigraphy; heart failure; radionuclide imaging; splanchnic pressure-volume relations

References

  1. Fallick C, Sobotka PA, Dunlap ME. Sympathetically mediated changes in capacitance: Redistribution of the venous reservoir as a cause of decompensation. Circ Heart Fail 2011;4:669‐75. - PubMed
  2. Zile MR, Bennett TD, St John Sutton M, Cho YK, Adamson PB, Aaron MF, et al. Transition from chronic compensated to acute decompensated heart failure: Pathophysiological insights obtained from continuous monitoring of intracardiac pressures. Circulation 2008;118:1433‐41. - PubMed
  3. Miller WL. Fluid volume overload and congestion in heart failure: Time to reconsider pathophysiology and how volume is assessed. Circ Heart Fail 2016;9:e002922. - PubMed
  4. Fudim M, Hernandez AF, Felker GM. Role of volume redistribution in the congestion of heart failure. J Am Heart Assoc 2017. https://doi.org/10.1161/JAHA.117.006817 . - PubMed
  5. Lewin J, Ledwidge M, O’Loughlin C, McNally C, McDonald K. Clinical deterioration in established heart failure: What is the value of BNP and weight gain in aiding diagnosis? Eur J Heart Fail 2005;7:953‐7. - PubMed
  6. Fudim M, Boortz-Marx RL, Ganesh A, DeVore AD, Patel CB, Rogers JG, et al. Splanchnic nerve block for chronic heart failure. JACC Heart Fail 2020;8:742‐52. - PubMed
  7. Alzahri MS, Rohra A, Peacock WF. Nitrates as a treatment of acute heart failure. Card Fail Rev 2016;2:51‐5. - PubMed
  8. Dupuis J, Lalonde G, Lebeau R, Bichet D, Rouleau JL. Sustained beneficial effect of a seventy-two hour intravenous infusion of nitroglycerin in patients with severe chronic congestive heart failure. Am Heart J 1990;120:625‐37. - PubMed
  9. Bussmann WD, Kaltenbach M. Sublingual nitroglycerin in the treatment of left ventricular failure and pulmonary edema. Eur J Cardiol 1976;4:327‐33. - PubMed
  10. Taylor AL, Ziesche S, Yancy C, Carson P, D’Agostino R Jr, Ferdinand K, et al. Combination of isosorbide dinitrate and hydralazine in blacks with heart failure. N Engl J Med 2004;351:2049‐57. - PubMed
  11. Elkayam U, Johnson JV, Shotan A, Bokhari S, Solodky A, Canetti M, et al. Double-blind, placebo-controlled study to evaluate the effect of organic nitrates in patients with chronic heart failure treated with angiotensin-converting enzyme inhibition. Circulation 1999;99:2652‐7. - PubMed
  12. Gelman S, Mushlin PS. Catecholamine-induced changes in the splanchnic circulation affecting systemic hemodynamics. Anesthesiology 2004;100:434‐9. - PubMed
  13. Price HL, Deutsch S, Marshall BE, Stephen GW, Behar MG, Neufeld GR. Hemodynamic and metabolic effects of hemorrhage in man, with particular reference to the splanchnic circulation. Circ Res 1966;18:469‐74. - PubMed
  14. Sandler MP, Kronenberg MW, Forman MB, Wolfe OH, Clanton JA, Partain CL. Dynamic fluctuations in blood and spleen radioactivity: Splenic contraction and relation to clinical radionuclide volume calculations. J Am Coll Cardiol 1984;3:1205‐11. - PubMed
  15. Bell L, Zaret BL, Rutlen DL. Influence of alpha-adrenergic receptor stimulation on splanchnic intravascular volume in conscious humans. Acta Physiol Scand 1991;143:65‐9. - PubMed
  16. Risöe C, Simonsen S, Rootwelt K, Sire S, Smiseth OA. Nitroprusside and regional vascular capacitance in patients with severe congestive heart failure. Circulation 1992;85:997‐1002. - PubMed
  17. Manyari DE, Wang Z, Cohen J, Tyberg JV. Assessment of the human splanchnic venous volume-pressure relation using radionuclide plethysmography. Effect of nitroglycerin. Circulation 1993;87:1142‐51. - PubMed
  18. Schneider AJ, Teule GJ, Groeneveld AB, Nauta J, Luth WJ, Thijs LG. The immediate effect of nitroglycerin on total body blood volume distribution in patients with congestive heart failure: A non-invasive study. Eur Heart J 1987;8:1119‐25. - PubMed
  19. Links JM, Becker LC, Shindledecker JG, Guzman P, Burow RD, Nickoloff EL, et al. Measurement of absolute left ventricular volume from gated blood pool studies. Circulation 1982;65:82‐91. - PubMed
  20. Dehmer GJ, Lewis SE, Hillis LD, Twieg D, Falkoff M, Parkey RW, et al. Nongeometric determination of left ventricular volumes from equilibrium blood pool scans. Am J Cardiol 1980;45:293‐300. - PubMed
  21. Kronenberg MW, Uetrecht JP, Dupont WD, Davis MH, Phelan BK, Friesinger GC. Intrinsic left ventricular contractility in normal subjects. Am J Cardiol 1988;61:621‐7. - PubMed
  22. Bell L, Hennecken J, Zaret BL, Rutlen DL. Alpha-adrenergic regulation of splanchnic volume and cardiac output in the dog. Acta Physiol Scand 1990;138:321‐9. - PubMed
  23. Scott-Douglas NW, Manyari DE, Smiseth OA, Robinson VJ, Wang SY, Smith ER, et al. Measurement of intestinal vascular capacitance in dogs: An application of blood pool scintigraphy. J Appl Physiol 1985;1995:232‐8. - PubMed
  24. Bell L, Rutlen DL. Quantitative radionuclide assessment of total pulmonary vascular volume changes. Can J Physiol Pharmacol 1990;68:727‐32. - PubMed
  25. Wang SY, Manyari DE, Scott-Douglas N, Smiseth OA, Smith ER, Tyberg JV. Splanchnic venous pressure-volume relation during experimental acute ischemic heart failure. Differential effects of hydralazine, enalaprilat, and nitroglycerin. Circulation 1995;91:1205‐12. - PubMed
  26. Smiseth OA, Manyari DE, Scott-Douglas NW, Wang Y, Kingma I, Smith ER, et al. The effect of nitroglycerin on pulmonary vascular capacitance in dogs. Am Heart J 1991;121:1454‐9. - PubMed
  27. Kadowitz PJ, Nandiwada P, Gruetter CA, Ignarro LJ, Hyman AL. Pulmonary vasodilator responses to nitroprusside and nitroglycerin in the dog. J Clin Invest 1981;67:893‐902. - PubMed
  28. Loos D, Schneider R, Schörner W. Changes in regional body blood volume caused by nitroglycerin. Z Kardiol 1983;72:29‐32. - PubMed
  29. Leier CV, Bambach D, Thompson MJ, Cattaneo SM, Goldberg RJ, Unverferth DV. Central and regional hemodynamic effects of intravenous isosorbide dinitrate, nitroglycerin and nitroprusside in patients with congestive heart failure. Am J Cardiol 1981;48:1115‐23. - PubMed
  30. Abrams J. Hemodynamic effects of nitroglycerin and long-acting nitrates. Am Heart J 1985;110:216‐24. - PubMed
  31. Rankin JS, Olsen CO, Arentzen CE, Tyson GS, Maier G, Smith PK, et al. The effects of airway pressure on cardiac function in intact dogs and man. Circulation 1982;66:108‐20. - PubMed
  32. Peters J, Hecker B, Neuser D, Schaden W. Regional blood volume distribution during positive and negative airway pressure breathing in supine humans. J Appl Physiol 1985;1993:1740‐7. - PubMed
  33. Stewart JM, Montgomery LD. Reciprocal splanchnic-thoracic blood volume changes during the Valsalva maneuver. Am J Physiol Heart Circ Physiol 2005;288:H752‐8. - PubMed
  34. Burkhoff D, Tyberg JV. Why does pulmonary venous pressure rise after onset of LV dysfunction: A theoretical analysis. Am J Physiol 1993;265:H1819‐28. - PubMed
  35. Brooksby GA, Donald DE. Dynamic changes in splanchnic blood flow and blood volume in dogs during activation of sympathetic nerves. Circ Res 1971;29:227‐38. - PubMed
  36. Brunner MJ, Shoukas AA, MacAnespie CL. The effect of the carotid sinus baroreceptor reflex on blood flow and volume redistribution in the total systemic vascular bed of the dog. Circ Res 1981;48:274‐85. - PubMed
  37. Schmitt M, Blackman DJ, Middleton GW, Cockcroft JR, Frenneaux MP. Assessment of venous capacitance. Radionuclide plethysmography: Methodology and research applications. Br J Clin Pharmacol 2002;54:565‐76. - PubMed
  38. Birch DJ, Turmaine M, Boulos PB, Burnstock G. Sympathetic innervation of human mesenteric artery and vein. J Vasc Res 2008;45:323‐32. - PubMed
  39. Wang SY, Scott-Douglas NW, Manyari DE, Tyberg JV. Arterial versus venous changes in vascular capacitance during nitroprusside infusion: A vascular modelling study. Can J Physiol Pharmacol 1999;77:131‐7. - PubMed
  40. Shoukas AA, Bohlen HG. Rat venular pressure-diameter relationships are regulated by sympathetic activity. Am J Physiol 1990;259:H674‐80. - PubMed
  41. Wang SY, Manyari DE, Tyberg JV. Cardiac vagal reflex modulates intestinal vascular capacitance and ventricular preload in anesthetized dogs with acute myocardial infarction. Circulation 1996;94:529‐33. - PubMed
  42. Lawson MA, Hansen DE, Gupta DK, Bell SP, Adkisson DW, Mallugari RR, et al. Modification of ventriculo-arterial coupling by spironolactone in nonischemic dilated cardiomyopathy. ESC Heart Fail 2021. https://doi.org/10.1002/ehf2.13161 . - PubMed

Publication Types

Grant support