Kishimoto Shinji, Maruhashi Tatsuya, Kajikawa Masato, Harada Takahiro, Yamaji Takayuki, Han Yiming, Mizobuchi Aya, Hashimoto Yu, Yoshimura Kenichi, Nakano Yukiko, Chayama Kazuaki, Goto Chikara, Yusoff Farina Mohamad, Nakashima Ayumu, Higashi Yukihito
Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima 734-8551, Japan.
Division of Regeneration and Medicine, Medical Center for Translational and Clinical Research, Hiroshima University Hospital, Hiroshima 734-8551, Japan.
J Clin Med. 2021 Dec 20;10(24):5980. doi: 10.3390/jcm10245980.
The purpose of this study was to evaluate whether heart failure with mildly reduced ejection fraction (HFmrEF) is associated with vascular dysfunction and whether vascular function predicts future deterioration of LVEF in patients with HFmrEF. We evaluated endothelial function assessed by flow-mediated vasodilation (FMD) and vascular smooth muscle function assessed by nitroglycerine-induced vasodilation (NID) in 69 patients with HFmrEF and 426 patients without HF and evaluated the future deterioration of LVEF, defined as a decrease in LVEF to <40%, in 39 patients with HFmrEF for up to 3 years. Both FMD and NID were significantly lower in patients with HFmrEF than in patients without HF. We categorized patients into two groups based on low tertiles of NID: a low group (NID of <7.0%) and an intermediate and high group (NID of ≥7.0%). There were significant differences between the Kaplan-Meier curves for the deterioration of LVEF in the two groups ( < 0.01). Multivariate Cox proportional hazard analysis revealed that NID of <7.0% was an independent predictor of future deterioration of LVEF in patients with HFmrEF. Both endothelial function and vascular smooth muscle function are impaired in patients with HFmrEF compared with those in patients without HF. In addition, low NID of <7.0% predicts future deterioration of LVEF.
本研究的目的是评估射血分数轻度降低的心力衰竭（HFmrEF）是否与血管功能障碍相关，以及血管功能是否能预测HFmrEF患者左心室射血分数（LVEF）的未来恶化情况。我们评估了69例HFmrEF患者和426例无心力衰竭患者的内皮功能（通过血流介导的血管舒张功能评估）和血管平滑肌功能（通过硝酸甘油诱导的血管舒张功能评估），并对39例HFmrEF患者长达3年的LVEF未来恶化情况进行了评估，LVEF未来恶化定义为LVEF降至<40%。HFmrEF患者的血流介导的血管舒张功能和硝酸甘油诱导的血管舒张功能均显著低于无心力衰竭患者。我们根据硝酸甘油诱导的血管舒张功能的低三分位数将患者分为两组：低分组（硝酸甘油诱导的血管舒张功能<7.0%）和中高分组（硝酸甘油诱导的血管舒张功能≥7.0%）。两组LVEF恶化的Kaplan-Meier曲线存在显著差异（<0.01）。多因素Cox比例风险分析显示，硝酸甘油诱导的血管舒张功能<7.0%是HFmrEF患者LVEF未来恶化的独立预测因素。与无心力衰竭患者相比，HFmrEF患者的内皮功能和血管平滑肌功能均受损。此外，硝酸甘油诱导的血管舒张功能<7.0%可预测LVEF的未来恶化。
