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Heart. May 1999; 81(5): 512–517.
PMCID: PMC1729027

Effects of L-arginine on lower limb vasodilator reserve and exercise capacity in patients with chronic heart failure


OBJECTIVE—To determine whether the reactive hyperaemic response of the lower limb increases with improved exercise capacity after acute supplementation with L-arginine, the precursor of nitric oxide, in patients with chronic heart failure.
METHODS—19 patients with chronic heart failure were enrolled in the study. Rest calf blood flow and femoral occlusion induced calf blood flow changes were measured by venous occlusion plethysmography before and after intravenous infusion of 10% L-arginine solution (5 ml/kg for 30 minutes) or placebo. Postexercise calf blood flow was also measured after the experimental infusion. During both postinfusion periods, several exercise capacity indices were determined by a symptom limited cardiopulmonary exercise test using a bicycle ergometer.
RESULTS—Baseline calf blood flow, systemic blood pressure, and heart rate showed no significant changes in either of the two experimental conditions. However, the occlusion induced blood flow response was significantly enhanced by L-arginine infusion (mean (SEM) peak flow, 19.6 (1.5) v 28.9 (3.1) ml/min/dl calf tissue; p < 0.01), but not by placebo (peak flow, 19.1 (1.4) v 20.9 (1.8) ml/min/dl calf tissue; NS). Calf blood flow response after exercise was also higher after L-arginine infusion than after placebo (peak flow, 4.8 (0.4) v 6.0 (0.8) ml/min/dl calf tissue; p < 0.05). L-arginine infusion had no significant effect compared with placebo on exercise capacity indices such as peak oxygen uptake (17.1 (1.0) v 15.8 (1.1) ml/min/kg; NS), anaerobic threshold (10.5 (0.6) v 10.4 (0.7) ml/min/kg; NS), and exercise time (296 (23) v 283 (22) s; NS).
CONCLUSIONS—Acute supplementation with the nitric oxide precursor L-arginine increased lower limb reactive hyperaemia but did not lead to any significant improvement in exercise capacity in patients with chronic heart failure.

Keywords: congestive heart failure; nitric oxide; endothelium; arginine; exercise

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Selected References

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Figures and Tables

Figure 1
Study protocol. Blood, blood sampling; BP/HR, blood pressure and heart rate; CBF, calf blood flow; EX test, symptom limited cardiopulmonary exercise test; RH, reactive hyperaemia.
Figure 2
Calf blood flow response after abrupt release of five minute thigh occlusion before ([composite function (small circle)]) and after (•) infusion of L-arginine (upper panel) and placebo (lower panel) in patients with chronic heart failure. Error bars = SEM. ...
Figure 3
Calf blood flow response after ergometric exercise after L-arginine (•) and placebo ([composite function (small circle)]) infusion in patients with chronic heart failure. Error bars = SEM.
Figure 4
Changes in peak oxygen uptake (peak VO2) (left), anaerobic threshold (AT) (centre), and exercise (EX) time (right) measured after infusion of L-arginine ([composite function (small circle)]) and placebo (•) in patients with chronic heart failure.

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