Abstract 3827: Chronic PDE5-Inhibition With Sildenafil Improves Diastolic Function and Clinical Status in Patients With Stable HF
Objectives. To test the effects on LV diastolic function and clinical status in a cohort of heart failure (HF) patients treated with chronic PDE5-inhibitor.
Background. In CHF, a defective nitric oxide (NO) signalling may be involved in LV diastolic abnormalities. PDE5-inhibition, by blocking NO degradation and overexpressing cellular cGMP pathways might be beneficial.
Methods. 48 stable HF patients were randomly assigned to placebo (n=24) or sildenafil at the dose of 50 mg three times a day (n=24) in addition to their current drug treatment for 1 year, with assessments (at 6 months and 1 year) of LV diastolic function, by studying conventional transmitral and Tissue Doppler indices, cardiopulmonary exercise performance and quality of life.
Results In the sildenafil group only, at 6 months and 1 year we observed an improvement in functional performance (peak VO2 ml • min-1 • kg-1; from 13. to 17.4 and 18.0; p<0.01), exercise ventilation efficiency (ventilation to CO2 production slope; from 36.2 to 33.0 and 30.0; p<0.01) and quality of life (breathlessness score; from 25.2 to 17.1 and 17.2; p<0.01). Chronic PDE5 inhibition significantly increased early diastolic Tissue Doppler velocities (E1) at the lateral mitral (from 4.5 to 5.8 and 6.0) and septal (from 4.1 to 5.9 and 6.4) annuli and reduced the ratio of early trasmitral (E) to E1 lateral (from 13.8 to 9.4 and 8.5) compared with placebo (p<0.01 for each comparison). No adverse effects were noted, but flushing in 3 patients and headache in 4 patients.
Conclusions. Our findings confirm that in HF, sildenafil therapy improves functional capacity and clinical status and provide the first evidence that LV diastolic function properties are an additional target of benefits related to chronic PDE5 inhibition.