Abstract 12265: Prognostic Significance of Peripheral Endothelial Dysfunction in Heart Failure With Reduced Left Ventricular Ejection Fraction
Background: Endothelial dysfunction plays a crucial role in heart failure (HF). However, relation between peripheral endothelial function and prognosis remains unknown in patients with HF with reduced left ventricular ejection fraction (HFREF). We investigated the relation between endothelial function and cardiovascular (CV) outcomes in HFREF patients.
Methods: We performed a prospective cohort study of 338 HFREF patients (symptoms of HF and left ventricular ejection fraction [LVEF] ≤50%), admitted in Kumamoto University Hospital and Yokohama City University Medical Center between September 2006 and December 2012. Peripheral endothelial function was noninvasively assessed by using reactive hyperemia peripheral arterial tonometry as reactive hyperemia index (RHI) and we followed CV events (composite of CV death, non-fatal myocardial infarction or ischemic stroke, unstable angina, hospitalization for HF, or coronary revascularization).
Results: The low-RHI group (RHI≤0.49) had significantly higher grade of New York Heart Association Functional Classification, lower LVEF, and higher levels of B-type natriuretic peptide (BNP) compared to the high-RHI group. Overall, 104 CV events were recorded during the follow-up period (median: 26 months). The low-RHI group had a significant higher probability of CV events compared to the high-RHI group by the Kaplan-Meier analysis (log-rank test: p=0.004). Multivariable Cox hazard analysis with significant factors in univariate analysis (RHI, age, male, systolic blood pressure, hemoglobin [Hb], estimated glomerular filtration rate, and BNP) identified RHI (hazard ration [HR]: 0.88, 95% confidence interval [CI]: 0.79-0.98, p=0.015), male (HR: 2.01, 95%-CI: 1.27-3.16, p=0.007), Hb (HR: 0.89, 95%-CI: 0.80-0.98, p=0.017) and Ln[BNP] (HR: 1.28, 95% CI 1.08-1.52, p=0.005) as independent predictors for CV events. In the model with factors associated with occurrence of CV events in previous studies of HFREF, RHI (HR: 0.83, 95%-CI 0.74-0.93, p=0.002) was also a significant predictor for CV events.
Conclusion: Peripheral endothelial dysfunction predicted future CV events in HFREF patients. Assessment of endothelial function by RHI is clinically useful for the risk stratification and management in HFREF.
- © 2013 by American Heart Association, Inc.