Nakamura M, Arakawa N, Yoshida H, Saitoh S, Kon H, Hiramori K
Second Department of Internal Medicine, Iwate Medical University, Morioka, Japan.
J Card Fail. 2001 Mar;7(1):38-44. doi: 10.1054/jcaf.2001.22426.
Several reports have shown that dilatory response to acetylcholine (ACh) and nitroprusside (SNP) is blunted in the limb vasculature in patients with congestive heart failure (CHF). However, it is not yet known whether this vascular dysfunction is related to clinical outcome. We have examined the relationship between peripheral vasodilatory response and prognosis of CHF.
A total of 46 patients with mild to moderate CHF were enrolled (mean age 56 years). Changes in forearm blood flow (FBF) during intra-arterial infusion of ACh and SNP were determined by plethysmography. FBF changes above baseline for each dose were cumulated and used as an index of endothelium-dependent (ACh) response and endothelium-independent (SNP) response, respectively. During the follow-up period (mean 32 months), 9 patients were admitted to the hospital for treatment of worsening refractory CHF, and 6 patients died suddenly or developed life-threatening arrhythmia. By Kaplan-Meier analysis, when all cardiac events were included, no significant differences were observed between any levels of vascular response in terms of prognosis. However, when deterioration events were analyzed separately, patients with SNP responses below the median (7.4 mL/min/dL) had significantly higher rates of hospital admission caused by worsening CHF than those with above the median responses (P <.05). This relationship was not found between ACh response and clinical outcome. By Cox multivariate analysis, blunted vasodilatory response to SNP was a significant predictor of worsening CHF (chi(2) = 3.95; P <.05).
This study has shown that patients with mild to moderate CHF showing a blunted vascular response to SNP rather than ACh were admitted to the hospital more frequently because of deterioration of CHF. This finding suggests that changes in vascular smooth muscle and/or vascular structure in the peripheral vasculature may be a critical element in the worsening of CHF.
多项报告显示，充血性心力衰竭（CHF）患者肢体血管对乙酰胆碱（ACh）和硝普钠（SNP）的舒张反应减弱。然而，尚不清楚这种血管功能障碍是否与临床结局相关。我们研究了外周血管舒张反应与CHF预后之间的关系。
共纳入46例轻至中度CHF患者（平均年龄56岁）。通过体积描记法测定动脉内输注ACh和SNP期间前臂血流量（FBF）的变化。将每个剂量下高于基线的FBF变化累加，分别用作内皮依赖性（ACh）反应和非内皮依赖性（SNP）反应的指标。在随访期（平均32个月）内，9例患者因难治性CHF恶化入院，6例患者突然死亡或发生危及生命的心律失常。通过Kaplan-Meier分析，当纳入所有心脏事件时，在任何血管反应水平方面，预后均未观察到显著差异。然而，当单独分析恶化事件时，SNP反应低于中位数（7.4 mL/min/dL）的患者因CHF恶化导致的住院率显著高于反应高于中位数的患者（P<.05）。在ACh反应与临床结局之间未发现这种关系。通过Cox多因素分析，对SNP的血管舒张反应减弱是CHF恶化的显著预测因素（χ2 = 3.95；P<.05）。
本研究表明，轻至中度CHF患者中，对SNP而非ACh的血管反应减弱的患者因CHF恶化而更频繁地入院。这一发现表明，外周血管中血管平滑肌和/或血管结构的变化可能是CHF恶化的关键因素。
