Predictive value of serial assessment of endothelial function in chronic heart failure
| Autor: | Mitsumasa Hirano, Yoshinobu Kitta, Jyun-ei Obata, Takamitsu Nakamura, Daisuke Fujioka, Hideto Mishina, Ken-ichi Kawabata, Tsuyoshi Kobayashi, Kazuhiro Watanabe, Kiyotaka Kugiyama, Yukio Saito, Yosuke Watanabe, Shun Tamaru, Isao Takishima |
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| Rok vydání: | 2012 |
| Předmět: |
Male
medicine.medical_specialty Brachial Artery Endothelium Myocardial Ischemia Vasodilation Risk Assessment Predictive Value of Tests Risk Factors medicine.artery Internal medicine medicine Humans Endothelial dysfunction Brachial artery Aged Proportional Hazards Models Heart Failure Proportional hazards model business.industry Middle Aged Atherosclerosis Prognosis medicine.disease Predictive value medicine.anatomical_structure Heart failure Predictive value of tests Chronic Disease cardiovascular system Cardiology Female Endothelium Vascular Cardiology and Cardiovascular Medicine business Follow-Up Studies circulatory and respiratory physiology |
| Zdroj: | International Journal of Cardiology. 158:417-422 |
| ISSN: | 0167-5273 |
| DOI: | 10.1016/j.ijcard.2011.01.059 |
| Popis: | It remains undefined whether reversibility of endothelial dysfunction after optimized therapies for heart failure (HF) provides prognostic information in patients with HF. This study examined whether changes in endothelial vasomotor function after therapies for HF may predict future outcomes in patients with stable HF.This study included 245 patients with stable chronic ischemic HF and an impaired flow-mediated dilation (FMD) of the brachial artery (FMD5.5%). Measurement of FMD was repeated after 6 months for individualized and optimized therapy for HF and atherosclerotic risk factors. Patients were followed for 36 months or until the occurrence of cardiac death or hospitalization with decompensated HF.FMD was persistently impaired (5.5%) in 130 (53%) patients after 6 months of the optimized therapy, whereas it improved (FMD ≥5.5%) in the remaining 115 (47%) patients. During follow-up, an event occurred in 26 (20%) patients with persistently impaired FMD and in 7 (6%) patients with improved FMD (p0.01). Multivariate Cox hazards analysis showed that persistent impairment of FMD was an independent predictor of cardiac events (hazard ratio 3.0, 95% CI 1.3-6.9, p=0.013). Persistently impaired FMD had a significantly incremental effect on the predictability of brain natriuretic peptide levels for cardiac events. Baseline FMD before the therapy for HF and atherosclerotic risk factors had no significant prognostic information.Persistent endothelial vasomotor dysfunction despite therapies for HF and atherosclerotic risk factors was a predictor of cardiac events in patients with chronic ischemic HF. |
| Databáze: | OpenAIRE |
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