title: Flow-mediated dilation normalization predicts outcome in chronic heart failure patients.
abstract: BACKGROUND
  Reduced flow-mediated dilation (FMD) is a known prognostic marker in heart failure (HF), but may be influenced by the brachial artery (BA) diameter. Aiming to adjust for this influence, we normalized FMD (nFMD) by the peak shear rate (PSR) and tested its prognostic power in HF patients.
  
  
  RESULTS
  BA diameter, FMD, difference in hyperemic versus rest brachial flow velocity (FVD), PSR (FVD/BA), and nFMD (FMD/PSR × 1000) were assessed in 71 HF patients. At follow-up (mean 512 days), 19 HF (27%) reached the combined endpoint (4 heart transplantations [HTs], 1 left ventricle assist device implantation [LVAD], and 14 cardiac deaths [CDs]). With multivariate Cox regression analysis, New York Heart Association functional class ≥III (hazard ratio [HR] 9.36, 95% confidence interval [CI] 2.11-41.4; P = .003), digoxin use (HR 6.36, 95% CI 2.18-18.6; P = .0010), FMD (HR 0.703, 95% CI 0.547-0.904; P = .006), PSR (HR 1.01, 95% CI 1.005-1.022; P = .001), FVD (HR 1.04, 95% CI 1.00-1.06; P = .02), and nFMD (HR 0.535, 95% CI 0.39-0.74; P = .0001) were predictors of unfavorable outcome. Receiver operating characteristic curve for nFMD showed that patients with nFMD >5 seconds had significantly better event-free survival than patients with nFMD ≤5 seconds (log-rank test: P < .0001).
  
  
  CONCLUSIONS
  nFMD is a strong independent predictor of CD, HT, and LVAD in HF with left ventricular ejection fraction <40%. Patients with nFMD >5 seconds have a better prognosis than those with lower values.
authors.affiliation: Division of Cardiology, Fondazione Salvatore Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico, Turin, Italy. franco.tarrogenta@fsm.it
authors.forename: Franco
authors.initials: F
authors.lastname: Tarro Genta
authors.forename: Ermanno
authors.initials: E
authors.lastname: Eleuteri
authors.forename: Pier Luigi
authors.initials: PL
authors.lastname: Temporelli
authors.forename: Fabio
authors.initials: F
authors.lastname: Comazzi
authors.forename: Massimo
authors.initials: M
authors.lastname: Tidu
authors.forename: Zoia
authors.initials: Z
authors.lastname: Bouslenko
authors.forename: Francesca
authors.initials: F
authors.lastname: Bertolin
authors.forename: Carlo
authors.initials: C
authors.lastname: Vigorito
authors.forename: Pantaleo
authors.initials: P
authors.lastname: Giannuzzi
authors.forename: Francesco
authors.initials: F
authors.lastname: Giallauria
mesh_terms: D000368:Aged; D001783:Blood Flow Velocity / Q000502:physiology*; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012307:Risk Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D014664:Vasodilation / Q000502:physiology*