Coggan, Andrew R.Broadstreet, Seth R.Mahmood, KiranMikhalkova, DeanaMadigan, MichaelBole, IndraPark, SooLeibowitz, Joshua L.Kadkhodayan, AnaThomas, Deepak P.Thies, DakkotaPeterson, Linda R.2017-11-082017-11-082017Coggan, A. R., Broadstreet, S. R., Mahmood, K., Mikhalkova, D., Madigan, M., Bole, I., … Peterson, L. R. (2017). Dietary Nitrate Increases VO2peak and Performance but Does Not Alter Ventilation or Efficiency in Patients with Heart Failure with Reduced Ejection Fraction. Journal of Cardiac Failure. https://doi.org/10.1016/j.cardfail.2017.09.004https://hdl.handle.net/1805/14477Background Patients with heart failure with reduced ejection fraction (HFrEF) exhibit lower efficiency, dyspnea, and diminished peak oxygen uptake (VO2peak) during exercise. Dietary nitrate (NO3−), a source of nitric oxide (NO), has improved these measures in some studies of other populations. We determined the effects of acute NO3− ingestion on exercise responses in 8 patients with HFrEF using a randomized, double-blind, placebo-controlled, crossover design. Methods and Results Plasma NO3−, nitrite (NO2−), and breath NO were measured at multiple time points and respiratory gas exchange was determined during exercise after ingestion of beetroot juice containing or devoid of 11.2 mmol of NO3−. NO3− intake increased (P < .05–0.001) plasma NO3− and NO2− and breath NO by 1469 ± 245%, 105 ± 34%, and 60 ± 18%, respectively. Efficiency and ventilation during exercise were unchanged. However, NO3− ingestion increased (P < .05) VO2peak by 8 ± 2% (ie, from 21.4 ± 2.1 to 23.0 ± 2.3 mL.min−1.kg−1). Time to fatigue improved (P < .05) by 7 ± 3 % (ie, from 582 ± 84 to 612 ± 81 seconds). Conclusions Acute dietary NO3− intake increases VO2peak and performance in patients with HFrEF. These data, in conjunction with our recent data demonstrating that dietary NO3− also improves muscle contractile function, suggest that dietary NO3− supplementation may be a valuable means of enhancing exercise capacity in this population.enPublisher Policynitric oxideheart failureVO2 peakArticle