Author + information
- Received November 24, 2004
- Revision received April 4, 2005
- Accepted April 13, 2005
- Published online September 20, 2005.
- Brigitte Meyer, MD,
- Deddo Mörtl, MD,
- Karin Strecker, MD,
- Martin Hülsmann, MD,
- Vanessa Kulemann, MD,
- Thomas Neunteufl, MD,
- Richard Pacher, MD and
- Rudolf Berger, MD⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Rudolf Berger, Department of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
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.
- Received November 24, 2004.
- Revision received April 4, 2005.
- Accepted April 13, 2005.
- American College of Cardiology Foundation