Heart failure & cardiomyopathies
Impact of Acute Antioxidant and Tetrahydrobiopterin (BH 4 ) Administration on Locomotor Muscle Microvascular Function in Patients With Heart Failure
Authors' conclusion
Together, these results provide new evidence for the efficacy of acute BH 4 administration to improve some aspects of locomotor muscle microvascular function in patients with HFrEF and HFpEF, with no apparent benefit of AOx administration, alone or in combination with BH 4 , in either group. These findings lend further conceptual support for the nitric oxide pathway as a modifiable target in the treatment of heart failure.
Study context
- Population
- Patients with heart failure with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF)HFrEF 14 · HFpEF 19
- Comparison
- BH 4, AOx and BH 4 +AOx compared with placebo
Primary result
As reported in the abstract
Peak change in leg blood flow (passive limb movement)
| Group | HFrEF | HFpEF |
|---|---|---|
| Placebo | 234±31 | 269±33 |
| BH 4 | 357±45 | 367±47 |
| BH 4 +AOx | 355±49 | 394±65 |
HFrEF
Placebo234±31
BH 4357±45
BH 4 +AOx355±49
HFpEF
Placebo269±33
BH 4367±47
BH 4 +AOx394±65
- AOx vs placebo: P = 0.60 — HFrEF; not statistically different
- AOx vs placebo: P = 0.61 — HFpEF; not statistically different
- BH 4 vs placebo: P = 0.033 — improved, in both HFrEF and HFpEF
- BH 4 +AOx vs placebo: P = 0.019 — improved, in both HFrEF and HFpEF
Further findings
| Outcome | Placebo | BH 4 | BH 4 +AOx | P value |
|---|---|---|---|---|
| CRP (C-reactive protein)BH 4 vs placebo · HFpEF; lower with BH 4 · per-group values are HFpEF | 4268±547 ng/mL | 2721±391 ng/mL | 2779±376 ng/mL | P = 0.007 |
| CRP (C-reactive protein)BH 4 +AOx vs placebo · HFpEF; lower with BH 4 +AOx · per-group values are HFpEF | P = 0.007 |
- Total hyperemic response to passive limb movement (leg blood flow area under the curve) · BH 4 vs placebo · HFpEF; increased
- P = 0.016
- Total hyperemic response to passive limb movement (leg blood flow area under the curve) · BH 4 +AOx vs placebo · HFpEF; increased
- P = 0.040
- Total hyperemic response to passive limb movement (leg blood flow area under the curve) — HFrEF: not statistically different across treatments
- P =0.29
- CRP (C-reactive protein) — HFrEF: not statistically different
- P =0.39
Original publication
Impact of Acute Antioxidant and Tetrahydrobiopterin (BH 4 ) Administration on Locomotor Muscle Microvascular Function in Patients With Heart Failure. Circ Heart Fail. Published 24 April 2025. doi:10.
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