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Vascular endothelial function predicts mortality risk in patients with advanced ischaemic chronic heart failure †
Author(s) -
Shechter Michael,
Matetzky Shlomi,
Arad Michael,
Feinberg Micha S.,
Freimark Dov
Publication year - 2009
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1093/eurjhf/hfp053
Subject(s) - medicine , ejection fraction , heart failure , cardiology , brachial artery , myocardial infarction , proportional hazards model , discontinuation , exacerbation , endothelial dysfunction , blood pressure
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.