title: Vascular endothelial function predicts mortality risk in patients with advanced ischaemic chronic heart failure.
abstract: OBJECTIVE
  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.
  
  
  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 > or = 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.
  
  
  CONCLUSIONS
  Flow-mediated dilation is associated with increased mortality risk in ischaemic ACHF patients.
authors.affiliation: Heart Institute, Chaim Sheba Medical Center, 52621 Tel Hashomer, Israel. shechtes@netvision.net.il
authors.forename: Michael
authors.initials: M
authors.lastname: Shechter
authors.forename: Shlomi
authors.initials: S
authors.lastname: Matetzky
authors.forename: Michael
authors.initials: M
authors.lastname: Arad
authors.forename: Micha S
authors.initials: MS
authors.lastname: Feinberg
authors.forename: Dov
authors.initials: D
authors.lastname: Freimark
mesh_terms: D000328:Adult; D000368:Aged; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D004452:Echocardiography; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D018608:Ultrasonography, Doppler