Key result
In dogs with heart failure, CXL-1020 increased ejection fraction from 27% to 40% (P<0.05), and in patients with systolic HF, it reduced filling pressures and increased cardiac index.
Why the study?
Does the novel pure HNO donor CXL-1020 improve myocardial function and hemodynamics in experimental models and patients with systolic heart failure?
Does the novel pure HNO donor CXL-1020 improve myocardial function and hemodynamics in experimental models and patients with systolic heart failure?
CXL-1020, a novel pure nitroxyl donor, demonstrates positive inotropic and vasodilator effects in experimental models and provides first-in-man evidence of hemodynamic improvement in patients with systolic heart failure.
Answers are grounded in this paper and cite their sources.
Hypothesis-generating for HNO donors in systolic HF; leaves open effects on clinical outcomes pending randomized trials.
BACKGROUND: The nitroxyl (HNO) donor, Angeli's salt, exerts positive inotropic, lusitropic, and vasodilator effects in vivo that are cAMP independent. Its clinical usefulness is limited by chemical instability and cogeneration of nitrite which itself has vascular effects. Here, we report on effects of a novel, stable, pure HNO donor (CXL-1020) in isolated myoctyes and intact hearts in experimental models and in patients with heart failure (HF). METHODS AND RESULTS: CXL-1020 converts solely to HNO and inactive CXL-1051 with a t1/2 of 2 minutes. In adult mouse ventricular myocytes, it dose dependently increased sarcomere shortening by 75% to 210% (50-500 μmol/L), with a ≈30% rise in the peak Ca(2+) transient only at higher doses. Neither inhibition of protein kinase A nor soluble guanylate cyclase altered this contractile response. Unlike isoproterenol, CXL-1020 was equally effective in myocytes from normal or failing hearts. In anesthetized dogs with coronary microembolization-induced HF, CXL-1020 reduced left ventricular end-diastolic pressure and myocardial oxygen consumption while increasing ejection fraction from 27% to 40% and maximal ventricular power index by 42% (both P<0.05). In conscious dogs with tachypacing-induced HF, CXL-1020 increased contractility assessed by end-systolic elastance and provided venoarterial dilation. Heart rate was minimally altered. In patients with systolic HF, CXL-1020 reduced both left and right heart filling pressures and systemic vascular resistance, while increasing cardiac and stroke volume index. Heart rate was unchanged, and arterial pressure declined modestly. CONCLUSIONS: These data show the functional efficacy of a novel pure HNO donor to enhance myocardial function and present first-in-man evidence for its potential usefulness in HF. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifiers: NCT01096043, NCT01092325.
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Sabbah et al. (2013) studied Heart failure. CXL-1020 was evaluated on Hemodynamic and echocardiographic parameters. In dogs with heart failure, CXL-1020 increased ejection fraction from 27% to 40% (P<0.05), and in patients with systolic HF, it reduced filling pressures and increased cardiac index.
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