University of Yamanashi, Faculty of Medicine, Department of Internal Medicine II, Chuo, Yamanashi, Japan.
Int J Cardiol. 2012 Jul 26;158(3):417-22. doi: 10.1016/j.ijcard.2011.01.059. Epub 2011 Mar 2.
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 (FMD <5.5%). 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 (p<0.01). 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.
心力衰竭（HF）优化治疗后内皮功能障碍的可逆性是否为 HF 患者提供预后信息仍未明确。本研究旨在探讨 HF 治疗后血管内皮舒缩功能的变化是否可预测稳定 HF 患者的未来结局。
本研究纳入 245 例稳定的慢性缺血性 HF 且肱动脉血流介导的舒张功能（FMD）受损（FMD<5.5%）的患者。在接受个体化和优化 HF 及动脉粥样硬化危险因素治疗 6 个月后重复 FMD 测量。患者随访 36 个月或直至发生心脏性死亡或因失代偿性 HF 住院。
在优化治疗 6 个月后，130 例（53%）患者的 FMD 持续受损（<5.5%），而其余 115 例（47%）患者的 FMD 改善（FMD≥5.5%）。随访期间，26 例（20%）持续 FMD 受损的患者和 7 例（6%）FMD 改善的患者发生了事件（p<0.01）。多变量 Cox 风险分析显示，持续的 FMD 受损是心脏事件的独立预测因素（风险比 3.0，95%CI 1.3-6.9，p=0.013）。持续的 FMD 受损对脑钠肽水平预测心脏事件的能力有显著的附加作用。HF 和动脉粥样硬化危险因素治疗前的基础 FMD 对预后无显著预测价值。
尽管进行了 HF 和动脉粥样硬化危险因素的治疗，但内皮血管舒缩功能持续障碍是慢性缺血性 HF 患者心脏事件的预测因素。
