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(Circulation. 2005;111:58-62.)
© 2005 American Heart Association, Inc.

Heart Failure

Endothelial Cell Activation in Patients With Decompensated Heart Failure

Paolo C. Colombo, MD; Javier E. Banchs, MD; Sulejman Celaj, MD; Ashok Talreja, MD; Justine Lachmann, MD; Shailesh Malla, MD; Nicholas B. DuBois, MD; Anthony W. Ashton, PhD; Farhana Latif, MD; Ulrich P. Jorde, MD; J. Anthony Ware, MD; Thierry H. LeJemtel, MD

From the Department of Medicine (J.E.B., S.C., A.T., J.L., S.M., N.B.D., A.W.A., F.L., J.A.W., T.H.L.), Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY, and the Department of Medicine (P.C.C., U.P.J.), Division of Cardiology, New York–Presbyterian Hospital, New York, NY.

Correspondence to Thierry H. LeJemtel, MD, Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY 10461. E-mail lejemtel{at}aecom.yu.edu

Received June 11, 2004; revision received August 30, 2004; accepted September 29, 2004.

Background— Vascular endothelial functions, other than nitric oxide (NO)–mediated control of vasomotor tone, are poorly characterized in patients with chronic heart failure (CHF). Veins and arteries are exposed to the same circulating proinflammatory mediators in patients with CHF. The present study tested whether endothelial cell activation occurs in veins of patients with decompensated CHF and whether activation, if present, subsides with return to a clinically compensated state.

Methods and Results— Fifteen patients with decompensated CHF requiring transient inotropic support and 6 age-matched, healthy controls were studied. Endothelial cells and blood were collected from a forearm vein, and brachial artery flow–mediated dilation (FMD) was measured before and 24 hours after discontinuation of short-term inotropic therapy, when patients had returned to a steady compensated state. Nitrotyrosine immunoreactivity (an intracellular marker of oxidative stress), cyclooxygenase-2 (COX-2), and inducible NO synthase (iNOS) expression were significantly higher in venous endothelial cells of patients in clinical decompensation when compared with healthy subjects. Return to a compensated state resulted in a significant reduction in nitrotyrosine immunoreactivity, COX-2, and iNOS expression. Concomitantly, a significant increase in FMD and a decline in plasma total 8-isoprostane and bicycloprostaglandin E₂ levels were observed. Venous endothelial NOS expression was unaffected by clinical decompensation.

Conclusions— Clinical decompensation in CHF is associated with activation of the venous endothelium. Return to a compensated state after short-term inotropic therapy results in a significant reduction in endothelial nitrotyrosine formation, COX-2, and iNOS expression.

Key Words: heart failure • endothelium • inflammation

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