Objectives.: The aim of this study was to evaluate the hemodynamic effect of l-arginine infusion in patients with congestive heart failure. Background.: Endothelium-dependent vasodilation is impaired in patients with congestive heart failure. Nitric oxide, which was identified as endothelium-derived relaxing factor, is generated by nitric oxide synthase from l-arginine. Our hypothesis was that administration of l-arginine in patients with congestive heart failure may increase nitric oxide production and have a beneficial hemodynamic effect. Methods.: Twelve patients with congestive heart failure (New York Heart Association class II or III) due to coronary artery disease (left ventricular ejection fraction <35%) were given 20 g of l-arginine by intravenous infusion over 1 h at a constant rate. Stroke volume, cardiac output and left ventricular ejection fraction were determined with Doppler echocardiography at baseline and at 30 and 60 min and 1 h after the end of infusion. Blood and urinary levels of nitrite/nitrate (NO2/NO3), stable metabolites of nitric oxide, were measured and clearance was calculated. Results.: One hour of infusion of l-arginine resulted in a significant increase in stroke volume (from 68 ± 18 ml to 76 ± 23 ml [mean ± SD], p = 0.014) and cardiac output (from 4.07 ± 1.22 liters/min to 4.7 ± 1.42 liters/min, p = 0.006) without a change in heart rate. Mean arterial blood pressure decreased (from 102 ± 11 mm Hg to 89 ± 9.5 mm Hg, p < 0.002), and systemic vascular resistance decreased significantly. Within 1 h after cessation of l-arginine infusion, blood pressure, stroke volume, cardiac output and systemic vascular resistance were statistically not different from baseline values. Clearance of NO2/NO3 increased significantly during l-arginine administration (from 13.28 ± 0.42 ml/min to 29.97 ± 1.09 ml/min, p < 0.001). Conclusions.: Infusion of l-arginine in patients with congestive heart failure results in increased production of nitric oxide, peripheral vasodilation and increased cardiac output, suggesting a beneficial hemodynamic and possibly therapeutic profile. © 1995 American College of Cardiology.
Koifman, B., Wollman, Y., Bogomolny, N., Chernichowsky, T., Finkelstein, A., Peer, G., … Keren, G. (1995). Improvement of cardiac performance by intravenous infusion of l-arginine in patients with moderate congestive heart failure. Journal of the American College of Cardiology, 26(5), 1251–1256. https://doi.org/10.1016/0735-1097(95)00318-5