Enterosalivary nitrate metabolism and the microbiome: Intersection of microbial metabolism, nitric oxide and diet in cardiac and pulmonary vascular health.

Due to the cyclic function of the human heart, pressure and flow in the circulation are pulsatile rather than continuous. Addressing pulsatile haemodynamics starts with the most convenient measurement, brachial pulse pressure, which is widely available, related to development and treatment of heart failure (HF), but often confounded in patients with established HF. The next level of analysis consists of central (rather than brachial) pressures and, more importantly, of wave reflections. The latter are closely related to left ventricular late systolic afterload, ventricular remodelling, diastolic dysfunction, exercise capacity, and, in the long-term, the risk of new-onset HF. Wave reflection may also represent a suitable therapeutic target. Treatments for HF with preserved and reduced ejection fraction, based on a reduction of wave reflection, are emerging. A full understanding of ventricular-arterial coupling, however, requires dedicated analysis of time-resolved pressure and flow signals, which can be readily accomplished with contemporary non-invasive imaging and modelling techniques. This review provides a summary of our current understanding of pulsatile haemodynamics in HF.

Pulsatile arterial haemodynamics in heart failure.

The hallmark symptom of chronic heart failure (HF) is severe exercise intolerance. Impaired perfusive and diffusive O2 transport are two of the major determinants of reduced physical capacity and l...

Exercise limitations in heart failure with reduced and preserved ejection fraction.

Endothelial dysfunction and reduced nitric oxide (NO) signaling are key abnormalities leading to skeletal muscle oxygen delivery-utilization mismatch and poor physical capacity in patients with hea

https://www.physiology.org/doi/pdf/10.1152/ajpregu.00263.2016

Dietary nitrate supplementation and exercise tolerance in patients with heart failure with reduced ejection fraction

Dietary Nitrate Increases VO2peak and Performance but Does Not Alter Ventilation or Efficiency in Patients With Heart Failure With Reduced Ejection Fraction.

Dietary nitrate increases exercise tolerance in patients with non-ischemic, dilated cardiomyopathy—a double-blind, randomized, placebo-controlled, crossover trial Conor P. Kerley, BSc, James O. O’Neill, MD, Venu Reddy Bijjam, MD, Ciara Blaine, BSc, Philip E. James, PhD, and Liam Cormican, MD From the Department of Clinical Cardiology, Connolly Hospital, Blanchardstown, Dublin, Ireland; School of Medicine and Medical Sciences, University College Dublin, Belfield, Dublin, Ireland; Respiratory and Sleep Diagnostics Department, Connolly Hospital, Blanchardstown, Dublin, Ireland; and the Wales Heart Research Institute, Cardiff University Medical School, Cardiff, UK.

/pdf/dietary-nitrate-increases-exercise-tolerance-in-patients-1proszjjam.pdf

Dietary nitrate increases exercise tolerance in patients with non-ischemic, dilated cardiomyopathy-a double-blind, randomized, placebo-controlled, crossover trial.

Ciara Blaine

Papers

Dietary nitrate increases exercise tolerance in patients with non-ischemic, dilated cardiomyopathy-a double-blind, randomized, placebo-controlled, crossover trial.