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Chronic and Acute Heart Failure

Omran H, Illien S, MacCarter D, et al. D-ribose improves diastolic function and quality of life in congestive heart failure patients: a prospective feasibility study. Eur J Heart Fail 2003;5:615-619.

Heart failure is thought to be an energy deficient state, particularly during times of oxygen deprivation, such as during ischemia. D-ribose, a pentose monosaccharide, is hypothesized to restore myocardial ATP stores, and improve cardiac function. This randomized, double blind, crossover study investigated the effect of D-ribose on diastolic function and quality of life in 15 patients with chronic coronary artery disease and HF. Enrollees had known chronic stable coronary artery disease and NYHA functional class II or III HF. Each treatment phase was 3 weeks in duration, during which participants took D-ribose or placebo (5 grams of powder, mixed with water three times daily). Following a washout period of one week, participants were crossed over to the alternative arm for an additional 3 weeks. Outcome measures completed at baseline and at the end of each treatment phase included cardiac function by transthoracic echocardiography and exercise tolerance measured with an exercise ergometer, as well as quality of life (QoL) measured with the SF-36 questionnaire. Participants were NYHA functional classes II (N=7) and III (N=8) with a mean ejection fraction of 47.5 ± 1% (range 28-71%). Medications were not altered during the study. Echocardiography results revealed improvements in restrictive parameters associated with diastolic HF (a significantly shorter deceleration time of the E wave (p<0.002), a smaller left atrial volume (p<0.02), and higher percentage of atrial contribution to left ventricular filling (p<0.02)) after the D-ribose arm, and no significant changes following the placebo arm. Peak exercise tolerance was not affected by either treatment. QoL scores improved in participants after the D-ribose arm (417 ± 118 to 467 ± 128, p<0.01) but were not changed significantly in the placebo arm. Comparisons of study outcomes (echocardiography, exercise, and QoL variables) between D-ribose and placebo groups were not reported. It is unclear whether a one week washout period is enough for outcome values to return to baseline if in fact there were benefits from D-ribose, or whether long term treatment would provide a sustained benefit.

MacCarter D, Vijay N, Washam M, et al. D-ribose aids advanced ischemic heart failure patients. Int J Cardiol 2008; in press. Doi: 10.1016/j.ijcard.2008.05.025. (Letter to the editor)

This open label study examined the effects of D-ribose on ventilation efficiency in 16 adults (mean age 72 ± 10 years) with NYHA functional classes III (n=9) and IV (n=7) HF. Participants underwent sub-maximal cardiopulmonary exercise testing at baseline and after 8 weeks, which involved 6 minutes of exercise using an 8 inch step platform. Investigators measured ventilation efficiency (VEeff), oxygen uptake efficiency, oxygen pulse at anaerobic threshold (AT = the point at which lactate starts accumulating in the blood), maximal oxygen uptake (VO2) at AT, VT/VCO2 at AT, and HR/VT at AT. Inspired and expired air was measured directly with a monitor and accompanying software. D-ribose was dosed at 5 grams three times daily. Participants exhibited significant improvements in VEeff (51.5 ± 9.7 to 43.2 ± 8.5, p<0.005; normal values 25-34), VO2max (8.4 ± 1.5 to 10.0 ± 1.2 mL/kg/min, p<0.005), as well as oxygen uptake efficiency (1.12 ± 0.38 to 1.4 ± 0.41, p<0.02). Adverse events were not reported by the investigators. Although interesting, study design issues should be considered when interpreting results, such as the lack of a placebo group. Additionally, patients' concomitant medications were not described and it was unclear if dose changes and titrations were allowed during the study.