Abstract 3892: Persistent Impairment of Endothelial Vasomotor Function Has an Adverse Effect on Long-term Outcomes in Patients With Chronic Ischemic Heart Failure
Although endothelial vasomotor dysfunction represents an adverse outcome in patients with heart failure (HF), it remains undefined whether reversibility of endothelial dysfunction after therapies to HF provides prognostic information. This study assessed the hypothesis that changes in endothelial vasomotor function after optimized therapies for HF may predict future outcomes in HF patients.
Methods: This study included 183 consecutive patients with newly diagnosed chronic ischemic HF (≥ NYHA class II) who had an impairment of flow-mediated dilation of the brachial artery (FMD) at enrollment. All patients had LV systolic dysfunction (LVEF <50%) (68 patients in 1 vessel disease, 58 in 2 vessel disease, and 57 in 3 vessel disease). All patients had individualized, optimized therapies including medications and recommended life style changes for chronic HF according to the AHA guidelines. Measurement of FMD (expressed as percent dilation from baseline artery diameter) was performed at entry (1st FMD) and 6 months (2nd FMD) after therapies were initiated. After the 2nd FMD, all patients continued their same medications and were prospectively followed for 60 months or until occurrence of cardiac death or worsening HF requiring hospitalization. The impairment of FMD was defined as <5.5% (mean minus 1 SD of FMD in 100 age- and sex-matched normal subjects).
Results: FMD was persistently impaired (< 5.5%) in 99 (54%) patients at the 2nd FMD test, while it was improved (FMD ≥5.5%) in the remaining 84 (46%) patients. During the follow-up period, events occurred in 17 (17%) of the 99 patients with persistently impaired FMD and in 4 (4.8%) of the 84 patients with improved FMD (p<0.01). Using multivariate Cox proportional hazards analysis, persistent impairment of FMD was a predictor of future events that was independent of 1st FMD, use of medications, systolic blood pressure, BNP levels, and LVEF (HR 3.9, 95%CI 1.3– 8.4, p<0.01). In contrast, 1st FMD had no significant predictive value.
Conclusions: Patients with persistent impairment of endothelial function despite optimized therapies for HF are at increased risk of adverse outcomes in patients with chronic ischemic HF. Periodic measurement of FMD may be useful for identifying these higher risk individuals.