title: Reactive hyperemia is associated with adverse clinical outcomes in heart failure.
abstract: Impaired endothelial function, as assessed by brachial artery flow-mediated dilation (FMD), is an established risk factor for cardiovascular events. FMD is impaired in heart failure (HF) patients, but less is known about hyperemic brachial artery flow. We investigated the relationship between FMD and hyperemic flow with adverse clinical outcomes in HF patients.
  
  
  
  Brachial artery FMD and hyperemic flow were assessed in 156 patients (70.5 % Male; 45.5% Caucasian; mean age (± SD) = 56.2 (±12.4) years) with HF and reduced left ventricular ejection fraction (LVEF). Cox proportional hazard models were used to assess the potential explanatory association of FMD and hyperemic flow with the composite outcome of death or cardiovascular hospitalization over a median 5-year follow-up period.
  
  
  
  Both FMD and hyperemic flow were negatively correlated with age, but unrelated to sex, race, body mass index, LVEF or N-terminal pro-B-Type natriuretic peptide (NT-ProBNP). Reduced hyperemic flow, but not FMD, was associated with an increased risk of death or cardiac hospitalization after controlling for traditional risk factors.
  
  
  
  The association of reduced hyperemic flow with increased risk of adverse clinical outcomes suggests that micro-vascular function may be an important prognostic marker in patients with HF.
authors: Duke University Medical Center, Durham, NC.
authors: Nicola J
authors: NJ
authors: Paine
authors: University of North Carolina at Chapel Hill, Chapel Hill, NC.
authors: Alan L
authors: AL
authors: Hinderliter
authors: Duke University Medical Center, Durham, NC.
authors: James A
authors: JA
authors: Blumenthal
authors: University of North Carolina at Chapel Hill, Chapel Hill, NC.
authors: Kirkwood F
authors: KF
authors: Adams
authors: University of North Carolina at Chapel Hill, Chapel Hill, NC.
authors: Carla A
authors: CA
authors: Sueta
authors: University of North Carolina at Chapel Hill, Chapel Hill, NC.
authors: Patricia P
authors: PP
authors: Chang
authors: Duke University Medical Center, Durham, NC.
authors: Christopher M
authors: CM
authors: O'Connor
authors: Duke University Medical Center, Durham, NC. Electronic address: sherw002@mc.duke.edu.
authors: Andrew
authors: A
authors: Sherwood
mesh_terms: D000328:Adult; D000368:Aged; D001916:Brachial Artery / Q000503:physiopathology; D004730:Endothelium, Vascular / Q000503:physiopathology; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D006760:Hospitalization; D006801:Humans; D006940:Hyperemia / Q000453:epidemiology* / Q000503:physiopathology; D017078:Laser-Doppler Flowmetry; D008297:Male; D008875:Middle Aged; D009026:Mortality; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D013318:Stroke Volume; D014664:Vasodilation
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain