Clinical Research
Heart Failure and Cardiac Transplant
Flow-Mediated Vasodilation Predicts Outcome in Patients With Chronic Heart Failure: Comparison With B-Type Natriuretic Peptide

https://doi.org/10.1016/j.jacc.2005.04.060Get rights and content
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Objectives

The aim of this study was to assess the predictive potency of impaired endothelium-dependent flow-mediated vasodilation (FMD) in patients with chronic heart failure (CHF).

Background

Chronic heart failure is associated with reduced FMD; the prognostic impact of this observation is unknown.

Methods

Seventy-five ambulatory CHF patients (United Network of Organ Sharing [UNOS] status 2) with a left ventricular ejection fraction (LVEF) ≤30%, despite optimized medical therapy (angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker, 100%; beta-blocker, 81%), were evaluated. Using high-resolution ultrasound, FMD of the brachial artery was assessed in addition to other neurohormonal, clinical, and hemodynamic variables. Age, gender, New York Heart Association (NYHA) functional class, LVEF, hemodynamic variables, B-type natriuretic peptide (BNP) levels, medical therapy, cardiovascular risk factors, and FMD were analyzed for prediction of the combined end point conversion to UNOS status 1 or death in a multivariate Cox model.

Results

Up to three years, 21 patients (28%) converted to UNOS status 1, and 6 patients (8%) died. Univariate risk factors for the combined end point were log BNP (p = 0.0032), FMD (p = 0.0033), NYHA functional class (p = 0.0132), beta-blocker therapy (p = 0.0367), and mean blood pressure (p = 0.0406). In the multivariate analysis, only FMD (p = 0.0007), log BNP (p = 0.0032), and mean blood pressure (p = 0.0475) were independently related to the combined end point. In the Kaplan-Meier plot, significantly more patients with FMD <6.8% (median) reached the combined end point, as compared with patients with FMD >6.8% (p = 0.004).

Conclusions

In CHF, impaired FMD is a strong, independent predictor of conversion to UNOS status 1 or death.

Abbreviations and Acronyms

ACE
angiotensin-converting enzyme
BNP
B-type natriuretic peptide
CHF
chronic heart failure
DCM
dilated cardiomyopathy
FMD
(endothelium-dependent) flow-mediated vasodilation
HTx
heart transplantation
ICM
ischemic cardiomyopathy
LVEF
left ventricular ejection fraction
NMD
nitroglycerin-mediated vasodilation
NYHA
New York Heart Association
ROC
receiver-operating characteristic
UNOS
United Network for Organ Sharing

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