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March 18, 2015Circulation Heart FailureOpen Access

Effects of Sildenafil on Ventricular and Vascular Function in Heart Failure With Preserved Ejection Fraction

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Key result

In patients with HFpEF, sildenafil decreased arterial elastance (-0.29 vs +0.02 mm Hg/mL; P=0.008) but reduced left ventricular contractility (ΔPWR/EDV -52 vs +0 mm Hg/s; P=0.006) compared to placebo.

Why the study?

Does sildenafil improve ventricular and vascular function in patients with heart failure and preserved ejection fraction?

Population

48 subjects with heart failure and preserved ejection fraction participating in a prospective ancillary…

Comparison

Sildenafil vs Placebo

Design

RCT

Authors

BBBarry A. BorlaugGLGregory D. LewisSMSteven E. McNulty

Discussion

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Overview

Sildenafil's mixed ventricular-vascular effects in HFpEF warrant clinical caution; leaves open whether contractility reduction offsets vascular gains in larger trials.

Study Design

Type

RCT (n=48)

Structured PICO

Does sildenafil improve ventricular and vascular function in patients with heart failure and preserved ejection fraction?

P
Population
48 participants with heart failure and preserved ejection fraction from the RELAX trial.
I
Intervention
Sildenafil
C
Comparator
Placebo
O
Outcome
Changes in left ventricular contractility (peak power index and stroke work index), systemic arterial load (arterial elastance), right ventricular afterload (pulmonary artery systolic pressure), and endothelial function (reactive hyperemia index)surrogate

Main Result

Absolute Event Rate: -0.29% vs 0.02%

p-value: p=0.008

In patients with HFpEF, sildenafil reduces systemic arterial load but impairs left ventricular contractility, potentially explaining the lack of clinical benefit observed in the RELAX trial.

Cite This Study

Borlaug et al. (2015) conducted an RCT in Heart failure with preserved ejection fraction (n=48). Sildenafil vs. Placebo was evaluated on Arterial elastance (Ea) (p=0.008). In patients with HFpEF, sildenafil decreased arterial elastance (-0.29 vs +0.02 mm Hg/mL; P=0.008) but reduced left ventricular contractility (ΔPWR/EDV -52 vs +0 mm Hg/s; P=0.006) compared to placebo.

synapsesocial.com/papers/6a9ffcad26b4e28929efd5fahttps://doi.org/10.1161/circheartfailure.114.001915
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Effect of Phosphodiesterase-5 Inhibition on Exercise Capacity and Clinical Status in Heart Failure With Preserved Ejection Fraction2013 · 1,154 citations
  2. 2Sildenafil Improves Exercise Hemodynamics and Oxygen Uptake in Patients With Systolic Heart Failure2006 · 352 citations
  3. 3PDE5 Inhibition With Sildenafil Improves Left Ventricular Diastolic Function, Cardiac Geometry, and Clinical Status in Patients With Stable Systolic Heart Failure2010 · 383 citations
  4. 4Acute type 5 phosphodiesterase inhibition with sildenafil enhances flow-mediated vasodilation in patients with chronic heart failure2000 · 301 citations
  5. 5PhosphdiesteRasE-5 Inhibition to Improve CLinical Status and EXercise Capacity in Diastolic Heart Failure (RELAX) Trial2012 · 110 citations