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The effects of phosphodiesterase-5 inhibition with sildenafil on pulmonary hemodynamics and diffusion capacity, exercise ventilatory efficiency, and oxygen uptake kinetics in chronic heart failure

Marco Guazzi, MD, PhD, FACC^*,*, Gabriele Tumminello, MD^*, Fabio Di Marco, MD, Cesare Fiorentini, MD^* and Maurizio D. Guazzi, MD, PhD

^* Cardiopulmonary Laboratory, Cardiology Division, University of Milano, San Paolo Hospital, Milan, Italy
Respiratory Unit, University of Milano, San Paolo Hospital, Milan, Italy
Institute of Cardiology, University of Milano, Milan, Italy

View larger version (28K): [in a new window]   Figure 1 Cardiopulmonary exercising testing measurements (A, oxygen uptake [VO2] kinetics; B, slope of increase in ventilation versus carbon dioxide production [VE/VCO2 slope]; and C, rate of oxygen uptake increase per work rate [VO2/WR]) of one patient with moderate congestive heart failure secondary to ischemic cardiomyopathy (age 60 years, left ventricular ejection fraction of 34%, and systolic pulmonary pressure of 38 mm Hg) recorded after placebo and after sildenafil intake. Protocol consisted of 2 min of rest, 2 min of unloaded exercise at 60 rpm (Unl. Exe. ), ramp work rate of 15 W · min–1 to maximal exercise tolerance, and 6 min of recovery. Oxygen uptake kinetics data were computer-collected as breath-by-breath measurements, interpolated second-by-second, and averaged at 10-s intervals; VE/VCO2 incremental changes during maximal exercise data are plotted at 20-s intervals; VO2/WR incremental changes during maximal exercise data are plotted at 20-s intervals.

View larger version (13K): [in a new window]   Figure 2 Correlations of changes, after sildenafil, in lung diffusing capacity for carbon monoxide (DLco) versus brachial artery reactive hyperemia and changes in slope of increase in ventilation versus carbon dioxide output (VE/VCO2 slope) versus rate of oxygen uptake increase per work rate (VO2/WR) in patients with chronic heart failure.

View larger version (25K): [in a new window]   Figure 3 Correlations of changes in rate of oxygen uptake increase per work rate (VO2/WR) versus tau recovery and brachial artery hyperemia versus tau recovery, at baseline and after sildenafil, in patients with chronic heart failure.