title: Association between endothelial function and chronotropic incompetence in subjects with chronic heart failure receiving optimal medical therapy.
abstract: OBJECTIVE
  Impairment of flow-mediated, endothelium-dependent vasodilatation (FMD) of the brachial artery identifies peripheral endothelial dysfunction in subjects with chronic congestive heart failure (CHF) and is associated with increased morbidity and mortality. To further elucidate the interaction of peripheral and central mechanisms in the syndrome of CHF, we examined the association between endothelial function and chronotropic incompetence, an emerging prognostic marker in CHF.
  
  
  METHODS
  Thirty subjects with stable New York Heart Association (NYHA) functional class II-III CHF were studied. A vascular ultrasound study was performed to measure brachial artery FMD. The percentage of age-adjusted maximal predicted heart rate (MPHR) reached during cardiopulmonary exercise tolerance testing (CPETT) was used to assess the degree of chronotropic competence. All patients received ACE inhibitors and beta-adrenoceptor blockers.
  
  
  RESULTS
  Brachial artery FMD averaged 1.3 +/- 2.4% and age-adjusted % MPHR 74.1 +/- 11.7%. FMD correlated with % MPHR among all patients (r = 0.60, P = 0.01). FMD and resting heart rate (RHR) did not significantly correlate (r = 0.13, P = 0.55).
  
  
  CONCLUSIONS
  FMD, a measure of peripheral endothelial dysfunction, and % MPHR, a central determinant of cardiac output, are moderately correlated in heart failure patients receiving optimal medical therapy. Whether a cause-effect relationship underlies this association remains to be investigated.
authors.affiliation: Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, NY 10029-6574, USA.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Vittorio
authors.forename: Gregg
authors.initials: G
authors.lastname: Lanier
authors.forename: Ronald
authors.initials: R
authors.lastname: Zolty
authors.forename: Nitasha
authors.initials: N
authors.lastname: Sarswat
authors.forename: Chi-Hong
authors.initials: CH
authors.lastname: Tseng
authors.forename: Paolo C
authors.initials: PC
authors.lastname: Colombo
authors.forename: Ulrich P
authors.initials: UP
authors.lastname: Jorde
mesh_terms: D000328:Adult; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001916:Brachial Artery / Q000000981:diagnostic imaging; D004730:Endothelium, Vascular / Q000503:physiopathology*; D017079:Exercise Tolerance; D005260:Female; D006333:Heart Failure / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology*; D006334:Heart Function Tests; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D014463:Ultrasonography
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors