European Journal of Heart Failure Advance Access originally published online on April 30, 2009
European Journal of Heart Failure 2009 11(6):588-593; doi:10.1093/eurjhf/hfp053
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Vascular endothelial function predicts mortality risk in patients with advanced ischaemic chronic heart failure
1 Heart Institute, Chaim Sheba Medical Center, 52621 Tel Hashomer, Israel
2 The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
* Corresponding author. Tel: +972 3 5302645, Fax: +972 3 5343882, Email: shechtes{at}netvision.net.il
 |
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.
Key Words: Endothelium • Coronary disease • Heart failure • Prognosis
Received October 31, 2008; Revised February 25, 2009; Accepted March 3, 2009
Part of this study was presented as an abstract at the 57th Annual Scientific Session of the American College of Cardiology, Chicago, USA 2008.