Abstract 11860: Incremental 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 outcomes in HFREF patients.
Methods: This is a two-center prospective cohort study of 362 HFREF patients (symptoms of HF and left ventricular ejection fraction [LVEF] <50%) between September 2006 and December 2012. Peripheral endothelial function was noninvasively assessed by reactive hyperemia peripheral arterial tonometry (RH-PAT) as the natural logarithmic scaled reactive hyperemia index (Ln-RHI). We followed HF-related events (composite of cardiovascular death and HF-hospitalization).
Results: 82 HF-related events were recorded until 3-years follow-up. The lower-RHI group (Ln-RHI≤0.49, median) had a significantly higher probability of HF-related events compared to the higher-RHI group by the Kaplan-Meier method (log-rank test: p<0.001). Multivariable Cox hazard analysis with the significant factors by univariate analysis (systolic blood pressure, estimated glomerular filtration rate, Ln[B-type natriuretic peptide], LVEF, and Ln-RHI) identified Ln-RHI (per 0.1, hazard ratio: 0.84, 95% confidence interval [CI]: 0.75-0.95, p=0.005) as an independent predictor for HF-related events. Adding RHI to Meta-analysis Global Group in Chronic Heart Failure risk score (MAGGICs), which is powerful prognostic predictor of HF, significantly improved the risk classification by net reclassification index (NRI: 26.0%, p=0.002). MAGGICs added BNP and RHI significantly and incrementally predicted future HF-related events by the C-statistics (C-statistics, 95% CI: MAGGICs 0.612 [0.535-0.689], MAGGICs + Ln[BNP] + Ln-RHI 0.689 [0.626-0.751], p=0.019).
Conclusions: Peripheral endothelial dysfunction assessed by RHI was associated with future HF-related events in HFREF. RHI and BNP added to MAGGICs improved risk discrimination in HFREF.
Author Disclosures: K. Fujisue: None. S. Sugiyama: None. Y. Matsuzawa: None. E. Akiyama: None. K. Sugamura: None. J. Matsubara: None. H. Kurokawa: None. H. Maeda: None. Y. Hirata: None. H. Kusaka: None. E. Yamamoto: None. S. Iwashita: None. H. Sumida: None. K. Tsujita: None. K. Kaikita: None. S. Hokimoto: None. K. Matsui: None. H. Ogawa: Honoraria; Modest; AstraZeneca, Bayer, Pfizer, Sanofi, Takeda. Honoraria; Significant; Daiichi Sankyo, MSD. Other; Modest; Astellas, Astra Zeneca, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, Dainippon Sumitomo Pharma, Kowa, MSD, Novartis, Pfizer, Sanofi, and Takeda. Other; Significant; Bayer, Chugai, Otsuka.
- © 2014 by American Heart Association, Inc.