title: [Impaired endothelium-dependent forearm vasodilation in idiopathic dilated cardiomyopathy is related to severe left ventricular dysfunction and elevated serum tumor necrosis factor levels].
abstract: OBJECTIVE
  Endothelial dysfunction has been found in patients with idiopathic dilated cardiomyopathy (IDC), but its mechanism remains unknown. Our aim was to investigate whether forearm endothelium-dependent vasoreactivity correlates with cardiac disease severity or neurohormonal activation.
  
  
  METHODS
  We studied 23 patients with IDC and 10 healthy sex- and age-matched controls using brachial artery ultrasound to assess flow-mediated dilation (FMD) and nitroglycerin-induced vasodilation (NIV). In the IDC group, we determined plasma neurohormone and cytokine levels at the same time.
  
  
  RESULTS
  FMD was significantly less in the IDC group compared with the control group [--0.06 (2.8)% vs 4.4 (4.6)%, respectively; P<.01], whereas NIV was similar in both groups [15.0 (6.4)% vs 14.0 (7.4)%, respectively; P=NS]. FMD was significantly less in patients with poorer left ventricular (LV) function and more severe LV dilatation, and in those with a higher tumor necrosis factor-alpha (TNF-alpha) level. NIV was similar in all patient subgroups. There was a significant inverse correlation between the TNF-alpha plasma level and FMD (r=-0.75; P<.01). No correlation was found between the plasma levels of other neurohormones and FMD.
  
  
  CONCLUSIONS
  FMD, but not NIV, was impaired in patients with IDC compared with control subjects. In patients, there were significant associations between FMD impairment and the severity of LV dilatation, the severity of LV systolic dysfunction, and the plasma TNF-alpha level. The strongest correlation was observed between TNF-alpha plasma level and FMD. These data suggest that TNF-alpha may be implicated in endothelial dysfunction in patients with IDC.
authors.affiliation: Institut de Malalties Cardiovasculars, Hospital Clínic, IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Universidad de Barcelona, Barcelona, España.
authors.forename: Marta
authors.initials: M
authors.lastname: Sitges
authors.forename: Eulàlia
authors.initials: E
authors.lastname: Roig
authors.forename: Manel
authors.initials: M
authors.lastname: Morales
authors.forename: Manel
authors.initials: M
authors.lastname: Azqueta
authors.forename: Félix
authors.initials: F
authors.lastname: Pérez Villa
authors.forename: Carles
authors.initials: C
authors.lastname: Paré
authors.forename: Josefina
authors.initials: J
authors.lastname: Orús
authors.forename: Magda
authors.initials: M
authors.lastname: Heras
authors.forename: Ginés
authors.initials: G
authors.lastname: Sanz
mesh_terms: D001132:Arm / Q000098:blood supply; D002311:Cardiomyopathy, Dilated / Q000097:blood* / Q000150:complications / Q000503:physiopathology*; D004730:Endothelium, Vascular / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis*; D014664:Vasodilation; D018487:Ventricular Dysfunction, Left / Q000097:blood* / Q000150:complications / Q000503:physiopathology*
chemical_list: D014409:Tumor Necrosis Factor-alpha