The Nitric Oxide System in Patients with Chronic Heart Failure

Muyassar Mukhamedova*; Dina Arnopolskaya, PhD

Republican Specialized Scientific-Practical Medical Center of Therapy and Medical Rehabilitation, Tashkent, Uzbekistan
*Corresponding author: Muyassar Mukhamedova, Republican Specialized Scientific-Practical Medical Center of Therapy and Medical Rehabilitation. 4, Osiyo street, Yunusabad district, 100084, Tashkent, Republic of Uzbekistan. Fax/Tel: 998-90-1898300/998-90-9100804. E-mail:

Published: September 24, 2013


The aim of this study was to evaluate the metabolic features of nitric oxide (NO) in patients with chronic heart failure (CHF) of ischemic origin. The study included 303 patients with ischemic CHF who received the standard treatment for CHF. Evaluation of the functional status of the NO system included the detection of arginine concentrations in the peripheral blood, stable metabolites of nitric oxide (NO2/NO3) and endothelial NO synthase (eNOS) activity. After the initial assessment, patients were randomly divided into groups: the T-group who had torasemide (5-10 mg /day) included in the treatment scheme and the F-group with furosemide (20-40 mg/day). The diuretic dose was titrated according to the severity of the edema syndrome. In the randomly formed A-group of patients, L-arginine hydrochloride (Tivortin, URiA-PHARM, Ukraine) was administered in the treatment scheme for three months. The Tivortin dose was 6 g per day (10 mg syrup three times a day). The presence of diuretics in the treatment scheme allowed for normalizing the functioning of the NO system including eNOS activity. The additional use of L-arginine hydrochloride positively affected the NO metabolism.

chronic heart failure; torasemide; nitric oxide; arginine.
  1. Jankowska EA, Biel B, Majda J, Szklarska A, Lopuszanska M, Medras M,  et al. Anabolic deficiency in men with chronic heart failure: prevalence and detrimental impact on survival. Circulation 2006; 114(17):1829-37.
  2. Attanasio P, Anker SD, Doehner W, von Haehling S. Hormonal consequences and prognosis of chronic heart failure. Curr Opin Endocrinol Diabetes Obes 2011; 18(3): 224–30.
  3. Ball AM, Sole MJ. Oxidative stress and the pathogenesis of heart failure. Cardiol Clin 1998; 16(4):665–75.
  4. Singal PK, Khaper N, Palace V, Kumar D. The role of oxidative stress in the genesis of heart disease. Cardiovasc Res 1998; 40(3):426–32.
  5. Fitter WD. Free radicals and myocardial reperfusion injury. Br Med Bull 1993; 49(3):545–55.
  6. Giordano FJ. Oxygen, oxidative stress, hypoxia, and heart failure. J Clin Invest 2005; 115(3):500–8.
  7. Voloshin LV, Malakhov VA, Zavgorodnyaya AN. Endothelial dysfunction at cerebrovascular pathologies.  Kharkov; 2006. [Book in Russian].
  8. Malakhov VA, Bilous AM, Pasyura IM, Doroshenko GI. Cellular-membrane aspects of treatment and prevention for chronic cerebral ischemias and neurodegenerative processes.  Kharkov: Ranok; 1999. [Book in Russian].
  9. Saley AP, Retsky MI. The role of nitric oxide in the formation of motivational behavior and learning. Bulletin of HSI. Series: chemistry, biology, pharmacy 2003; 1:75-80. [Article in Russian].
  10. Somova LM, Plekhova NG. Nitric oxide as a mediator of inflammation. Bulletin of the Far Eastern Branch of RAS 2006; 6:70-80. [Article in Russian].
  11.  Bredt DS. Nitric Oxide in the Nervous System. Ed. by Vincent S. New York: Academic Press; 1995.
  12. Klahr S, Morrissey J. Angiotensin II and gene expression in the kidney. Am J Kidney Dis 1998; 31(1):171-6.
  13. Matsko MA. The ratio of certain neurotransmitters of stress-implementing and stress-limiting systems in the acute phase of ischemic stroke. Patholog Physiol Experem Therapy 2004; 4:14-6. Article in Russian].
  14. Kryzhanovsky GN Disregulatory pathology: A guide for physicians and biologists. - Moscow: Medicine; 2002.  [Book in Russian].
  15. Poletaev AB, Morozov SG, Kovalev IE. Regulatory metasystem. Immune -neuroendocrine regulation of homeostasis.  Moscow: Medicine; 2002.  [Book in Russian]
  16.  Sapolsky RM. Glucocorticoids, stress, and their adverse neurological effects: relevance to aging. Exp Gerontol 1999; 34(6):721-32.
  17. Palmer RM, Ashton DS, Moncada S. Vascular endothelial cells synthesize nitric oxide from L-arginine. Nature 1988; 333(6174):664–6.
  18. Bogdan C. Nitric oxide and the immune response. Nat Immunol 2001; 2(10):907-16.
  19. Fang FC.  Perspectives series: host/pathogen interactions. Mechanisms of nitric oxide-related antimicrobial activity. J Clin Invest 1997; 99(12):2818-2825.
  20. Nelson RG, Kriegsfeld LJ, Dawson VL, Dawson TM. Effects of nitric oxide on neuroendocrine function and behavior. Front in Neuroendocrinol 1997; 18(4):463-91.
  21.  Fontanive P, Saponati G, Iurato A, Volterrani C, Boni A, Piccioni L, et al. Effects of L-arginine on the Minnesota Living with Heart Failure Questionnaire quality-of-life score in patients with chronic systolic heart failure. Med Sci Monit 2009; 15(12):CR606-11.
  22. Hambrecht R, Hilbrich L, Erbs S, Gielen S, Fiehn E, Schoene N, et al. Correction of endothelial dysfunction in chronic heart failure: additional effects of exercise training and oral L-arginine supplementation. J Am Coll Cardiol 2000; 35(3):706-13.

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Int J Biomed. 2013; 3(3):180-183. © 2013 International Medical Research and Development Corporation. All rights reserved.