title: Clinical correlates of endothelial function in chronic heart failure.
abstract: OBJECTIVE
  There is a close link between heart failure and endothelial dysfunction. Brachial flow-mediated dilation (FMD) is a validated non-invasive measure of endothelial function. The aim of this study was to investigate the clinical correlates of FMD in patients with chronic heart failure (CHF).
  
  
  METHODS
  We evaluated 60 CHF outpatients (age 62 ± 14 years; 49 males, NYHA class 2.2 ± 0.7, left ventricular ejection fraction, LVEF, 33 ± 8%) taking conventional medical therapy (ACE-inhibitors and/or ARBs 93%, beta-blockers 95%) and in stable clinical conditions.
  
  
  METHODS
  The maximum recovery value of FMD was calculated as the ratio of the change in diameter (maximum-baseline) over the baseline value.
  
  
  RESULTS
  As compared with patients with a higher FMD, those with FMD below the median value (4.3%) were more frequently affected by ischemic cardiopathy (50 vs. 23%; p = 0.032) and diabetes mellitus (20 vs. 3%; p = 0.044), had a higher NYHA class (2.5 ± 0.5 vs. 1.9 ± 0.7; p < 0.001) and NT-proBNP (2,690 ± 3,690 vs. 822 ± 1,060; p = 0.001), lower glomerular filtration rate estimated by Cockcroft-Gault (GFRCG: 63 ± 28 vs. 78 ± 25; p = 0.001) and LVEF (29 ± 8 vs. 37 ± 9; p = 0.001), as well as more frequently showing a restrictive pattern (40 vs. 7%; p = 0.002). In a multivariate regression model (R (2) = 0.48; p < 0.001), FMD remained associated only with the NYHA class (p = 0.039) and diabetes mellitus (p = 0.024).
  
  
  CONCLUSIONS
  This study demonstrates that a better functional status and absence of diabetes mellitus are associated to higher FMD regardless of the etiology of the cardiac disease.
authors.affiliation: Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy. ciccone@cardio.uniba.it
authors.forename: Marco Matteo
authors.initials: MM
authors.lastname: Ciccone
authors.forename: Massimo
authors.initials: M
authors.lastname: Iacoviello
authors.forename: Agata
authors.initials: A
authors.lastname: Puzzovivo
authors.forename: Pietro
authors.initials: P
authors.lastname: Scicchitano
authors.forename: Francesco
authors.initials: F
authors.lastname: Monitillo
authors.forename: Francesco
authors.initials: F
authors.lastname: De Crescenzo
authors.forename: Vito
authors.initials: V
authors.lastname: Caragnano
authors.forename: Marco
authors.initials: M
authors.lastname: Sassara
authors.forename: Giovanni
authors.initials: G
authors.lastname: Quistelli
authors.forename: Pietro
authors.initials: P
authors.lastname: Guida
authors.forename: Stefano
authors.initials: S
authors.lastname: Favale
mesh_terms: D000368:Aged; D001916:Brachial Artery / Q000503:physiopathology*; D002908:Chronic Disease; D048909:Diabetes Complications; D004452:Echocardiography; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D012039:Regional Blood Flow; D014664:Vasodilation; D016277:Ventricular Function, Left
chemical_list: D020097:Natriuretic Peptide, Brain