Department of Cardiology, Research Unit IFIMAV, Cantabria University, Universitary Hospital Valdecilla, Santander, Spain.
Eur J Heart Fail. 2010 May;12(5):477-83. doi: 10.1093/eurjhf/hfq036. Epub 2010 Mar 30.
In congestive heart failure (CHF), arterial response is regulated by endothelial molecules. The aim of this study was to evaluate whether endothelial dysfunction (ED) was a predictor of outcome in a cohort of patients with heart failure.
Endothelial function was assessed in 242 patients with CHF by forearm reactive hyperaemia measured with intermittent venous occlusion plethysmography using a mercury strain gauge. The main endpoints were: 'total events' (death, heart attack, angina, stroke, NYHA class IV, or hospitalization due to heart failure) analysed using Cox regression for repeated events and 'death'. Patients were followed-up for 5 years. Post-hyperaemia forearm blood flow (PHFABF) was an independent predictor of total events [P = 0.01; hazard ratio [Exp(B)] 0.665, standard error (SE) 0.182]. Risk stratification by basal forearm blood flow (BFABF) showed that patients with basal blood flow above the median (3.03 mL min(-1) 100 mL(-1)) benefited from an increase in PHFABF, whereas in patients with a BFABF below the median, the increase in PHFABF did not diminish the risk of events. There was no relation between variations in PHFABF and death.
Post-hyperaemia forearm blood flow, as a measure of ED, is an independent predictor of major events in patients with CHF. A BFABF below the median is more predictive of an increased risk of complications.
在充血性心力衰竭（CHF）中，动脉反应受内皮分子调节。本研究旨在评估内皮功能障碍（ED）是否可预测心力衰竭患者队列的结局。
通过间歇性静脉闭塞体积描记法用汞应变规测量前臂反应性充血，评估 242 例 CHF 患者的内皮功能。主要终点为：使用 Cox 回归重复事件分析“总事件”（死亡、心脏病发作、心绞痛、中风、NYHA Ⅳ级或因心力衰竭住院）和“死亡”。患者随访 5 年。充血后前臂血流量（PHFABF）是总事件的独立预测因子[P = 0.01；风险比（Exp（B））0.665，标准误差（SE）0.182]。根据基础前臂血流量（BFABF）进行风险分层显示，基础血流量高于中位数（3.03 mL min(-1) 100 mL(-1))的患者，PHFABF 的增加可获益，而 BFABF 低于中位数的患者，PHFABF 的增加并不能降低事件风险。PHFABF 的变化与死亡之间没有关系。
作为 ED 的测量方法，充血后前臂血流量是 CHF 患者主要事件的独立预测因子。BFABF 低于中位数更能预测并发症风险增加。
