title: Endothelial dysfunction, measured by reactive hyperaemia using strain-gauge plethysmography, is an independent predictor of adverse outcome in heart failure.
abstract: OBJECTIVE
  In congestive heart failure (CHF), arterial response is regulated by endothelial molecules. The aim of this study was to evaluate whether endothelial dysfunction (ED) was a predictor of outcome in a cohort of patients with heart failure.
  
  
  RESULTS
  Endothelial function was assessed in 242 patients with CHF by forearm reactive hyperaemia measured with intermittent venous occlusion plethysmography using a mercury strain gauge. The main endpoints were: 'total events' (death, heart attack, angina, stroke, NYHA class IV, or hospitalization due to heart failure) analysed using Cox regression for repeated events and 'death'. Patients were followed-up for 5 years. Post-hyperaemia forearm blood flow (PHFABF) was an independent predictor of total events [P = 0.01; hazard ratio [Exp(B)] 0.665, standard error (SE) 0.182]. Risk stratification by basal forearm blood flow (BFABF) showed that patients with basal blood flow above the median (3.03 mL min(-1) 100 mL(-1)) benefited from an increase in PHFABF, whereas in patients with a BFABF below the median, the increase in PHFABF did not diminish the risk of events. There was no relation between variations in PHFABF and death.
  
  
  CONCLUSIONS
  Post-hyperaemia forearm blood flow, as a measure of ED, is an independent predictor of major events in patients with CHF. A BFABF below the median is more predictive of an increased risk of complications.
authors.affiliation: Department of Cardiology, Research Unit IFIMAV, Cantabria University, Universitary Hospital Valdecilla, Santander, Spain. joseramon@berrazueta.com
authors.forename: José R
authors.initials: JR
authors.lastname: de Berrazueta
authors.forename: Armando
authors.initials: A
authors.lastname: Guerra-Ruiz
authors.forename: María Teresa
authors.initials: MT
authors.lastname: García-Unzueta
authors.forename: Gema Martín
authors.initials: GM
authors.lastname: Toca
authors.forename: Rocío Sainz
authors.initials: RS
authors.lastname: Laso
authors.forename: María Sáez
authors.initials: MS
authors.lastname: de Adana
authors.forename: Miguel A Casanova
authors.initials: MA
authors.lastname: Martín
authors.forename: Manuel
authors.initials: M
authors.lastname: Cobo
authors.forename: Javier
authors.initials: J
authors.lastname: Llorca
mesh_terms: D002307:Cardiography, Impedance; D016001:Confidence Intervals; D004730:Endothelium, Vascular / Q000473:pathology*; D005260:Female; D005542:Forearm / Q000098:blood supply*; D006305:Health Status Indicators; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D006439:Hemodynamics; D006801:Humans; D006940:Hyperemia / Q000175:diagnosis*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013223:Statistics as Topic; D016896:Treatment Outcome