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September 5, 2007

Tilarginine in Patients With Acute Myocardial Infarction and Cardiogenic Shock

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2007;298(9):971-973. doi:10.1001/jama.298.9.971-b

To the Editor: The report of the TRIUMPH investigators1 showed a lack of benefit of NOS inhibition by L-NMMA in patients with MI complicated by cardiogenic shock. L-NMMA is closely related to ADMA. Both compounds are endogenously produced during the process of protein turnover and inhibit NOS with about equal potency.2 Plasma concentrations of ADMA were found to predict adverse outcome in patients with multiorgan failure,3 a common cause of death in cardiogenic shock.

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