Prognostic Significance of Peripheral Microvascular Endothelial Dysfunction in Heart Failure With Reduced Left Ventricular Ejection Fraction.
BACKGROUND
Endothelial dysfunction plays a crucial role in heart failure (HF), but the association between peripheral microvascular endothelial function assessed by reactive hyperemia peripheral arterial tonometry (RH-PAT) and prognosis remains unknown in HF with reduced left ventricular (LV) ejection fraction (HFREF). We prospectively investigated the association between peripheral microvascular endothelial function and HF-related near-future cardiovascular outcomes in HFREF patients.


RESULTS
The 362 HFREF patients (LVEF <50%) were followed for HF-related events (composite of cardiovascular death and HF hospitalization) up to 3 years. A natural logarithmic-scaled RH-PAT index (Ln-RHI) was obtained for each patient. A total of 82 HF-related events were recorded. The lower-RHI group (Ln-RHI ≤0.49, median) experienced a higher rate of HF-related events compared with the higher-RHI group by Kaplan-Meier analysis (30.9% vs. 14.4%, log-rank test: P<0.001). Multivariable Cox hazard analysis identified Ln-RHI as an independent predictor for HF-related events (per 0.1, hazard ratio: 0.84, 95% confidence interval: 0.75-0.95, P=0.005). Adding Ln-RHI to the Meta-analysis Global Group in Chronic HF risk score (MAGGICs) and Seattle Heart Failure Model (SHFM), powerful prognostic predictors of HF, significantly improved the net reclassification index (MAGGICs: 20.11%, P=0.02, SHFM: 24.88%, P<0.001), and increased the C-statistics for prediction of HF-related events (MAGGICs+Ln-RHI: from 0.612 to 0.670, SHFM+Ln-RHI: from 0.662 to 0.695).


CONCLUSIONS
Peripheral microvascular endothelial dysfunction assessed by RH-PAT was associated with future HF-related events in HFREF.
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University.
Koichiro
K
Fujisue
Seigo
S
Sugiyama
Yasushi
Y
Matsuzawa
Eiichi
E
Akiyama
Koichi
K
Sugamura
Junichi
J
Matsubara
Hirofumi
H
Kurokawa
Hirofumi
H
Maeda
Yoshihiro
Y
Hirata
Hiroaki
H
Kusaka
Eiichiro
E
Yamamoto
Satomi
S
Iwashita
Hitoshi
H
Sumida
Kenji
K
Sakamoto
Kenichi
K
Tsujita
Koichi
K
Kaikita
Seiji
S
Hokimoto
Kunihiko
K
Matsui
Hisao
H
Ogawa
D000368:Aged; D004727:Endothelium / Q000378:metabolism / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000378:metabolism / Q000473:pathology; D006801:Humans; D008297:Male; D055806:Microvessels / Q000378:metabolism / Q000473:pathology; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D013318:Stroke Volume