Chong Aun Yeong, Freestone Bethan, Patel Jeetesh, Lim Hoong Sern, Hughes Elizabeth, Blann Andrew D, Lip Gregory Y H
Haemostasis, Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, United Kingdom.
Am J Cardiol. 2006 Mar 1;97(5):671-5. doi: 10.1016/j.amjcard.2005.09.113. Epub 2006 Jan 10.
Congestive heart failure (CHF) is associated with marked endothelial dysfunction. We hypothesized that acute and chronic CHF may manifest different degrees of endothelial damage/dysfunction and activation, as reflected by different plasma endothelial markers, such as von Willebrand factor (vWF) and soluble thrombomodulin (both are indexes of endothelial damage/dysfunction) and soluble E-selectin (an index of endothelial activation). Second, we hypothesized a relation between endothelial markers and B-type natriuretic peptide (BNP, an index of cardiac function) in acute and chronic CHF that could be linked to prognosis. To test this hypothesis, we studied 35 patients with acute CHF, 40 patients with chronic CHF, and 32 healthy controls. The patients with CHF were followed up for the combined outcomes of cardiovascular death, nonfatal myocardial infarction, stroke, thromboembolism, and recurrent admissions to the hospital. vWF (p = 0.001), soluble thrombomodulin, E-selectin, and BNP (all p <0.0001) were higher in patients with acute and chronic CHF compared with controls. When the 2 CHF groups were compared, no significant differences were found in vWF or E-selectin (p = NS), but soluble thrombomodulin was significantly elevated in acute CHF (Tukey's post hoc test, p <0.05). Only high vWF was associated with a poorer outcome (log-rank test, p = 0.0188). None of the endothelial indexes correlated with plasma BNP. After a median follow-up of 18 months, only high (median or higher) vWF levels were predictive of adverse outcomes in the patients with CHF (log-rank statistic = 5.52, degree of freedom 1, p = 0.0188). In conclusion, despite similar ejection fractions, patients with acute and chronic CHF have different degrees of endothelial damage/dysfunction and activation, which may be related to differences in pathophysiology. High levels of vWF were associated with a worse short-term outcome. These endothelial markers were unrelated to plasma BNP levels and may imply a different release mechanism.
充血性心力衰竭（CHF）与明显的内皮功能障碍有关。我们推测，急性和慢性CHF可能表现出不同程度的内皮损伤/功能障碍和激活，这可通过不同的血浆内皮标志物反映出来，如血管性血友病因子（vWF）和可溶性血栓调节蛋白（两者均为内皮损伤/功能障碍的指标）以及可溶性E-选择素（内皮激活的指标）。其次，我们推测急性和慢性CHF中内皮标志物与B型利钠肽（BNP，心功能指标）之间存在关联，且这种关联可能与预后相关。为验证这一假设，我们研究了35例急性CHF患者、40例慢性CHF患者和32名健康对照者。对CHF患者进行随访，观察心血管死亡、非致命性心肌梗死、中风、血栓栓塞和再次入院的综合结局。与对照组相比，急性和慢性CHF患者的vWF（p = 0.001）、可溶性血栓调节蛋白、E-选择素和BNP（均p <0.0001）水平更高。当比较两个CHF组时，vWF或E-选择素无显著差异（p = NS），但急性CHF患者的可溶性血栓调节蛋白显著升高（Tukey事后检验，p <0.05）。只有高vWF水平与较差的结局相关（对数秩检验，p = 0.0188）。内皮指标均与血浆BNP无相关性。中位随访18个月后，只有高（中位数及以上）vWF水平可预测CHF患者的不良结局（对数秩统计量 = 5.52，自由度1，p = 0.0188）。总之，尽管射血分数相似，但急性和慢性CHF患者存在不同程度的内皮损伤/功能障碍和激活，这可能与病理生理学差异有关。高水平的vWF与较差的短期结局相关。这些内皮标志物与血浆BNP水平无关，可能意味着不同的释放机制。
