Endothelial dysfunction, measured by reactive hyperaemia using strain-gauge plethysmography, is an independent predictor of adverse outcome in heart failure

Aims In congestive heart failure (CHF), arterial response is regulated by endothelial molecules. The aim of this study was to evaluate whether endothelial dysfunction (ED) was a predictor of outcome in a cohort of patients with heart failure. Methods and results Endothelial function was assessed in...

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Published in:	European journal of heart failure Vol. 12; no. 5; pp. 477 - 483
Main Authors:	de Berrazueta, José R., Guerra-Ruiz, Armando, García-Unzueta, María Teresa, Martín Toca, Gema, Sainz Laso, Rocío, Sáez de Adana, María, Casanova Martín, Miguel A., Cobo, Manuel, LLorca, Javier
Format:	Journal Article
Language:	English
Published:	England Blackwell Publishing Ltd 01-05-2010
Subjects:	Cardiography, Impedance Confidence Intervals Endothelial function Endothelium, Vascular - pathology Female Forearm - blood supply Health Status Indicators Heart failure Heart Failure - complications Heart Failure - diagnosis Heart Failure - drug therapy Heart Failure - mortality Hemodynamics Humans Hyperemia - diagnosis Kaplan-Meier Estimate Male Middle Aged Post-hyperaemia forearm blood flow Prognosis Proportional Hazards Models Prospective Studies Reactive hyperaemia Risk Assessment Risk Factors Statistics as Topic Strain gauge plethysmography Treatment Outcome
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Summary:	Aims In congestive heart failure (CHF), arterial response is regulated by endothelial molecules. The aim of this study was to evaluate whether endothelial dysfunction (ED) was a predictor of outcome in a cohort of patients with heart failure. Methods and results Endothelial function was assessed in 242 patients with CHF by forearm reactive hyperaemia measured with intermittent venous occlusion plethysmography using a mercury strain gauge. The main endpoints were: ‘total events’ (death, heart attack, angina, stroke, NYHA class IV, or hospitalization due to heart failure) analysed using Cox regression for repeated events and ‘death’. Patients were followed‐up for 5 years. Post‐hyperaemia forearm blood flow (PHFABF) was an independent predictor of total events [P = 0.01; hazard ratio [Exp(B)] 0.665, standard error (SE) 0.182]. Risk stratification by basal forearm blood flow (BFABF) showed that patients with basal blood flow above the median (3.03 mL min−1 100 mL−1) benefited from an increase in PHFABF, whereas in patients with a BFABF below the median, the increase in PHFABF did not diminish the risk of events. There was no relation between variations in PHFABF and death. Conclusion Post‐hyperaemia forearm blood flow, as a measure of ED, is an independent predictor of major events in patients with CHF. A BFABF below the median is more predictive of an increased risk of complications.
Bibliography:	ark:/67375/WNG-GN8P3X0Q-T ArticleID:EJHFHFQ036 istex:8CA5ECE5D5DC1BAA598B9138D39DA3EF559F22BB ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1388-9842 1879-0844
DOI:	10.1093/eurjhf/hfq036