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This study aims to understand how nitroglycerin affects patients with acute heart failure, a condition where the heart struggles to pump blood effectively, leading to fluid buildup and breathing difficulties. Nitroglycerin relaxes blood vessels to ease the heart's workload and may help reduce fluid buildup. The investigators hypothesize that nitroglycerin can increase blood flow from the heart and promote urine production, which may reduce congestion in AHF patients. By studying heart function, blood volume, and fluid levels during treatment, the goal is to identify which patients may benefit most from nitroglycerin therapy.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Nitroglycerin | Experimental | Infusion of intravenous nitroglycerin titrated towards a vasodilatory state which we predefined as a 20-30% decrease in mean arterial pressure (MAP) for 1.5 hours followed by a phase of 1.5 hours with no vasodilation. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Nitroglycerin (NTG) | Drug | Infusion of intravenous nitroglycerin beginning at 2 microgram/kg/min (2 ml/hour) and titrated with the aim of a MAP reduction of 20-30%. Infusion rate will not be increased after the first 30 minutes and is limited to 0.1 µg/kg/min to 5 µg/kg/min. |
| Measure | Description | Time Frame |
|---|---|---|
| Stroke volume | Change in stroke volume (obtained from LiDCO) from baseline through vasodilation period. | From initiation of nitroglycerin infusion at time zero until study termination at 180 minutes. |
| Measure | Description | Time Frame |
|---|---|---|
| Cumulated urinary output (mL) | Measurement of cumulated urinary output after placement of a transurethral catheter. | From time zero until study termination at 180 minutes. |
| Mean arterial blood pressure |
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Inclusion Criteria:
Age ≥ 18 years
Clinical diagnosis of AHF requiring hospitalization
Systolic blood pressure ≥85 mmHg
Echocardiographic signs of cardiac dysfunction, by at least one of
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Hvidovre Hospital | Copenhagen | Denmark |
It is not possible for data to be shared due to legal reasons.
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| ID | Term |
|---|---|
| D000783 | Aneurysm |
| ID | Term |
|---|---|
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |
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| ID | Term |
|---|---|
| D005996 | Nitroglycerin |
| ID | Term |
|---|---|
| D009574 | Nitro Compounds |
| D009930 | Organic Chemicals |
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| From time zero throughout the study period until termination at time 180 minutes. |
| Heart rate | From time zero throughout the study period until termination at time 180 minutes. |
| Cardiac output | Measured by echocardiography. | At baseline and at timepoints 90 minutes and 180 minutes. |
| Peripheral perfusion index | As obtained by photoplethysmography, where a higher numerical value may indicate better peripheral tissue perfusion. | From time zero throughout the study period until termination at time 180 minutes. |
| Systemic vascular resistance | [SVR=(MAP-RAP)×80/CO] | From time zero throughout the study period until termination at time 180 minutes. |