Circulation, Vol 84, 2418-2425, Copyright © 1991 by American Heart Association
JM Arnold, GE Marchiori, JR Imrie, GL Burton, PW Pflugfelder and WJ Kostuk
BACKGROUND. Although progressive chronic congestive heart failure (CHF) is
associated with elevated systemic vascular resistance and increased
impedance to ventricular outflow, the contribution of changes in large
artery function has not been well documented in humans. METHODS AND
RESULTS. We studied 45 patients with a broad range of clinical severity of
CHF and compared noninvasive measurements of brachial artery diameter,
flow, and pulse wave velocity with 22 normal controls of similar age. In
CHF, mean arterial pressure was lower than in controls (85 +/- 1 versus 93
+/- 2 mm Hg, p less than 0.001), as were brachial artery diameter (4.07 +/-
0.10 versus 4.53 +/- 0.09 mm, p less than 0.001), flow (40.9 +/- 4.1 versus
70.9 +/- 11.5 ml.min-1, p less than 0.02), compliance (1.29 +/- 0.12 versus
2.00 +/- 0.18 cm4.dyne-1.10(- 7), p less than 0.002), and conductance (0.49
+/- 0.05 versus 0.76 +/- 0.13 units, p = 0.06). Limb vascular resistance
(40.2 +/- 5.0 versus 20.5 +/- 3.1 units, p less than 0.001) and pulse wave
velocity (10.6 +/- 0.5 versus 9.2 +/- 0.4 m.sec-1, p less than 0.03) were
higher than in controls. Brachial artery diameter was progressively lower
than in controls as severity of CHF increased (New York Heart Association
class II, 4.47 +/- 0.23 mm, p = NS; class III, 4.05 +/- 0.10 mm, p less
than 0.05; class IV, 3.71 +/- 0.28 mm, p less than 0.05). Similar changes
were observed for arterial compliance (class II, 1.76 +/- 0.32 cm4.dyne-
1.10(-7), p = NS; class III, 1.21 +/- 0.13 cm4.dyne-1.10(-7), p less than
0.05; class IV, 0.95 +/- 0.10 cm4.dyne-1.10(-7), p less than 0.05). While
the lower arterial pressure and flow might be expected to passively reduce
arterial diameter, this would be associated with a reduced pulse wave
velocity and improved arterial compliance, yet the opposite was observed.
Differences in large artery function were not likely caused by underlying
atherosclerosis alone, because patients with dilated cardiomyopathy and
patients with ischemic heart disease of the same sex, age, left ventricular
ejection fraction, and exercise treadmill duration had similar changes in
large artery function. CONCLUSIONS. We conclude that alterations in
brachial artery function are present in patients with moderate and severe
CHF. The observed reduction in arterial compliance, if present diffusely
throughout the arterial tree, could increase left ventricular end-systolic
stress directly and through increased velocity of reflected pressure waves
from the periphery.
ARTICLES
Large artery function in patients with chronic heart failure. Studies of brachial artery diameter and hemodynamics
Division of Cardiology, Victoria Hospital, London, Ontario, Canada.
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