Vascular endothelial function predicts mortality risk in patients with advanced ischaemic chronic heart failure

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Abstract

Aims: Endothelial function is impaired in advanced chronic heart failure (ACHF) patients. We explored a possible association between endothelial function and subsequent mortality risk in ACHF.Methods and results: We prospectively assessed brachial flow-mediated dilation (FMD) in 82 consecutive New York Heart Association class IV ischaemic ACHF patients with a mean left ventricular ejection fraction (LVEF) of 22 ± 3%. Following overnight fasting and discontinuation of all medications for ≥12 h, percent increase in FMD (%FMD) and nitroglycerin-mediated vasodilation were assessed using linear array ultrasound. All patients were followed for 14 ± 2 months for adverse cardiovascular events, including death, hospitalization for CHF exacerbation, or myocardial infarction. Patients were divided into two groups: those with an FMD lesser than or equal to the median %FMD of 4.6% (n = 41) and those with an FMD above the median (n = 41). Both groups were comparable regarding cardiovascular risk factors, LVEF, and concomitant medications. During follow-up, 22 (53.6%) patients with FMD lesser than or equal to the median had composite adverse cardiovascular events compared with only eight patients (19.5%) with FMD above the median (P < 0.01). Furthermore, fiver deaths (12.1%) occurred in patients with FMD lesser than or equal to the median, compared with no deaths in patients with FMD above the median (P < 0.03). Cox regression analyses revealed that FMD was an independent predictor for these events.Conclusion: Flow-mediated dilation is associated with increased mortality risk in ischaemic ACHF patients.

Original languageEnglish
Pages (from-to)588-593
Number of pages6
JournalEuropean Journal of Heart Failure
Volume11
Issue number6
DOIs
StatePublished - Jun 2009

Keywords

  • Coronary disease
  • Endothelium
  • Heart failure
  • Prognosis

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