Sustained benefits or oral pentaerythritol tetranitrate on ventricular function in chronic congestive heart failure

The hemodynamic effects of a single oral dose of 80 mg of pentaerythritol tetranitrate (PETN) were determined over a 5-hr period in 16 patients with chronic congestive heart failure. PETN decreased (p < 0.05) pulmonary capillary wedge pressure (27 to 18 mm Hb), right atrial pressure (15 to 9 mm Hg), mean systemic arterial pressure (89 to 80 mm Hg), and systemic vascular resistance (1,812 to 1,466 dynes x sec x cm-5). There were increases (p < 0.01) in cardiac index (2.0 to 2.3 l/m2/min), stroke volume index (24 to 28 ml/m2), and stroke work index (25 to 31 gm-m/m2). Peak reduction in pulmonary capillary wedge pressure occurred 2 hr after PETN and hemodynamic effects were still apparent at 5 hr. In nine patients in whom left and right ventricular ejection fractions were determined by radionuclide ventriculography before and after PETN, no changes were found in left ventricular ejection fraction (0.20 to 0.22, p = NS) although there was a modest increase in right ventricular ejection fraction (0.29 to 0.34, p < 0.05). The data indicate that oral PTEN may induce beneficial effects on preload and afterload in congestive cardiac failure that may last 5 or more hours.