Abstract 3191: Involvement of Endothelial Dysfunction Assessed by Peripheral Arterial Tonometry in Heart Failure With Preserved Left Ventricular Ejection Fraction
Backgrounds: Left ventricular (LV) diastolic dysfunction (DD) could play an important pathophysiological role in heart failure (HF) patients with normal LV ejection fraction (EF). Endothelial dysfunction has been involved in systolic HF, however, relationship between endothelial dysfunction and diastolic HF remains to be determined. Reactive hyperemia peripheral arterial tonometry (RH-PAT) is a noninvasive and automatic tool to evaluate endothelial function. We investigated the impact of endothelial dysfunction on LVDD and HF with preserved LVEF.
Methods and Results: We measured endothelial function assessed by RH-PAT using EndoPAT2000 in 296 consecutive patients with preserved LV systolic function (EF>50%, age 66.9±12.7, male 55%); 141 HF patients with LVDD (i;E/e′>15 or ii;8<E/e′<15 and BNP>200pg/ml) (HF-DD group; E/e′ 17.8±4.6, BNP 224±360pg/ml) and 155 control patients (E/e′ 9.2±2.2, BNP 34±36pg/ml). RH-PAT indexes were significantly lower in HF-DD group than control (1.64±0.29 vs. 1.92±0.41, P<0.01) and significantly correlated with E/e′ (r=−0.26, p<0.01). In HF-DD patients, RH-PAT indexes significantly decreased with New York Heart Association classification (I, 1.69±0.31, II, 1.54±0.16, III/IV, 1.40±0.19, P<0.01) and RH-PAT indexes were weakly correlated with BNP levels (r=−0.26, p<0.01). Patients with history of admission for decompensated congestive HF (n=33) had significantly lower RH-PAT indexes and higher BNP levels than those without the HF events (n=108) (RH-PAT index; 1.46±0.18 vs. 1.69±0.30, P<0.01, BNP; 558±580 vs. 120±148pg/ml, P<0.01). Stepwise upward multiple logistic regression analysis among various clinical factors including estimated glomerular filtration rate, E/e′ and LVEF demonstrated that BNP (odds ratio (OR) 1.007 [95% confidence interval (CI) 1.00 –1.01], P=0.001) and RH-PAT (per 0.1) (OR 0.48 [95% CI 0.33– 0.71], P<0.001) were independently associated with the hospitalized HF events in patients with LVDD.
Conclusions: Endothelial function was significantly attenuated in HF patients with LVDD, associated with the severity of HF symptom and history of HF events. Improvement of endothelial function might be a potential clinical target to improve prognosis in HF patients with preserved LVEF.