Document Detail

Predictive value of serial assessment of endothelial function in chronic heart failure.
MedLine Citation:
PMID:  21371765     Owner:  NLM     Status:  Publisher    
BACKGROUND: It remains undefined whether reversibility of endothelial dysfunction after optimized therapies for heart failure (HF) provides prognostic information in patients with HF. This study examined whether changes in endothelial vasomotor function after therapies for HF may predict future outcomes in patients with stable HF. METHODS: This study included 245 patients with stable chronic ischemic HF and an impaired flow-mediated dilation (FMD) of the brachial artery (FMD <5.5%). Measurement of FMD was repeated after 6months for individualized and optimized therapy for HF and atherosclerotic risk factors. Patients were followed for 36months or until the occurrence of cardiac death or hospitalization with decompensated HF. RESULTS: FMD was persistently impaired (<5.5%) in 130 (53%) patients after 6months of the optimized therapy, whereas it improved (FMD ≥5.5%) in the remaining 115 (47%) patients. During follow-up, an event occurred in 26 (20%) patients with persistently impaired FMD and in 7 (6%) patients with improved FMD (p<0.01). Multivariate Cox hazards analysis showed that persistent impairment of FMD was an independent predictor of cardiac events (hazard ratio 3.0, 95% CI 1.3-6.9, p=0.013). Persistently impaired FMD had a significantly incremental effect on the predictability of brain natriuretic peptide levels for cardiac events. Baseline FMD before the therapy for HF and atherosclerotic risk factors had no significant prognostic information. CONCLUSIONS: Persistent endothelial vasomotor dysfunction despite therapies for HF and atherosclerotic risk factors was a predictor of cardiac events in patients with chronic ischemic HF.
Isao Takishima; Takamitsu Nakamura; Mitsumasa Hirano; Yoshinobu Kitta; Tsuyoshi Kobayashi; Daisuke Fujioka; Yukio Saito; Kazuhiro Watanabe; Yosuke Watanabe; Hideto Mishina; Jyun-Ei Obata; Ken-Ichi Kawabata; Shun Tamaru; Kiyotaka Kugiyama
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-3-1
Journal Detail:
Title:  International journal of cardiology     Volume:  -     ISSN:  1874-1754     ISO Abbreviation:  -     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-3-4     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8200291     Medline TA:  Int J Cardiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
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