Abstract 13067: Incremental Prognostic Significance of Peripheral Endothelial Dysfunction for Cardiovascular Events in Patients with Heart Failure with Normal Left Ventricular Ejection Fraction
Background: Endothelial dysfunction plays an important role in the pathogenesis of heart failure (HF). We investigated whether endothelial dysfunction could predict future cardiovascular (CV) events in HF patients with normal left ventricular ejection fraction (HFNEF).
Methods: We evaluated cardiac function by using echocardiography to measure the ratio of early transmitral flow velocity to tissue Doppler early diastolic mitral annular velocity (E/e’), and assessed peripheral endothelial function by reactive hyperemia peripheral arterial tonometry (RH-PAT) in patients with HFNEF (n=257) and followed all patients until May 2011 or the occurrence of CV events (CV death, non-fatal myocardial infarction and ischemic stroke, unstable angina pectoris, re-hospitalization for HF, or coronary revascularization).
Results: During a mean follow-up of 21 months, 52 patients developed CV events. Kaplan-Meier analysis demonstrated a significantly higher probability of CV events in the low RHI group than in the high RHI group (log rank test P=0.02). Multivariate Cox hazard analysis identified RHI (hazard ratio[HR] 0.79, 95% confidence interval [CI] 0.66-0.93, P=0.006), E/e’ (HR 1.14, 95% CI 1.03-1.26, P=0.01), and B-type natriuretic peptide (BNP) (HR 1.67, 95% CI 1.33-2.09, P<0.001) as independent predictors of the future CV events. The C statistics for CV events increased when each parameter or combined parameters were added to HFNEF prognostic five factors (PF5) identified in I-PRESERVE study, including age, diabetes mellitus, New York Heart Association class, previous history of HF hospitalization, and left ventricular ejection fraction (C statistics values: PF5 alone 0.639, PF5+RHI 0.689; PF5+BNP 0.708, PF5+BNP+RHI 0.730; PF5+E/e’ 0.687, PF5+E/e’+RHI 0.723; PF5+BNP+E/e’ 0.708, PF5+BNP+E/e’+RHI 0.743), indicating the incremental significance of RHI for predicting CV outcomes.
Conclusions: Peripheral endothelial dysfunction assessed by RH-PAT independently correlated with the future CV events in patients with HFNEF. In combination with BNP and E/e’, endothelial dysfunction can significantly improve risk stratification in HFNEF.
- © 2011 by American Heart Association, Inc.