Results Of A One Year Study Of The Stability Of Intravenous Nitroglycerin In 5% Glutathione For Treating Adhf And Right Heart Failure Post Lvad Implantation

BACKGROUNDSuperoxide causes diuretic resistance which limits the treatment of ADHF and right heart failure post LVAD implantation. Formulating IV GTN in 5% GSH is expected to benefit both these conditions with GTN targeting heart failure and GSH preventing diuretic resistance. The purpose of this study is to evaluate the stability of a new formulation of intravenous nitroglycerin (GTN) for use in treating ADHF and right heart failure post LVAD implantation. METHODSa new protocol for formulating IV GTN in 5% GSH that is buffered with 2% L-arginine was used to create two solutions of GTN in 5% GSH. Following this the pH of two solutions of .2 mg/cc GTN in 5% GSH prepared according to the new protocol was tested. The solutions were then stored at room temperature for one year and observed for evidence of GSH oxidation. After one year, the pH of the solutions was retested. RESULTSinitial pH ranged 4.0 +/-.05 and was unchanged after one year. Both solutions remained clear without evidence of GSH oxidation. CONCLUSIONthis new formulation of IV GTN in 5% GSH is stable for use in treating ADHF and right heart failure post LVAD implantation for periods of up to one year. This new formulation has the potential to reduce the need for right ventricular assist devices following LVAD implantation and facilitate the explantation of LVADs thereby reducing the need for heart transplants. WHAT IS ALREADY KNOWN ON THIS TOPICDiuretic resistance (DR) is known to be associated with increased heart failure mortality. DR may be increased by superoxide which is intrinsic to the pathophysiology of heart failure. GSH depletion from the use of intravenous nitroglycerin in the treatment of ADHF and RHF leads to superoxide production and DR, both of which may be GSH suppressible. WHAT THIS STUDY ADDSThis study adds a new drug designed to prevent superoxide induced DR. HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICYThis study may lead to improved treatment of ADHF, prevention of RHF following LVAD implantation and facilitation of LVAD explantation for reducing the need for heart transplantation