Endothelial dysfunction, measured by reactive hyperaemia using strain-gauge plethysmography, is an independent predictor of adverse outcome in heart failure.
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.
de Berrazueta
José R
JR
Department of Cardiology, Research Unit IFIMAV, Cantabria University, Universitary Hospital Valdecilla, Santander, Spain. joseramon@berrazueta.com
Guerra-Ruiz
Armando
A
García-Unzueta
María Teresa
MT
Toca
Gema Martín
GM
Laso
Rocío Sainz
RS
de Adana
María Sáez
MS
Martín
Miguel A Casanova
MA
Cobo
Manuel
M
Llorca
Javier
J
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