Department of Cardiology, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
Department of Cardiology, 'Sotiria' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
Cardiol J. 2023;30(5):725-733. doi: 10.5603/CJ.a2022.0074. Epub 2022 Aug 17.
Heart failure (HF) is nowadays classified as HF with reduced ejection fraction (HFrEF), HF with mildly reduced EF (HFmrEF), and HF with preserved EF (HFpEF). Endothelial dysfunction (assessed by flow-mediated dilatation [FMD]), increased arterial stiffness (assessed by carotid-femoral pulse-wave velocity [PWV]), and galectin-3, a biomarker of myocardial fibrosis, have been linked to major adverse cardiovascular events (MACE) in patients with ischemic HF.
In this study we prospectively enrolled 340 patients with stable ischemic HF. We assessed the brachial artery FMD, carotid-femoral PWV, and galectin-3 levels, and patients were followed up for MACE according to HF group.
Interestingly, the FMD values exhibited a stepwise improvement according to left ventricular ejection fraction (LVEF) (HFrEF: 4.74 ± 2.35% vs. HFmrEF: 4.97 ± 2.81% vs. HFpEF: 5.94 ± ± 3.46%, p = 0.01), which remained significant after the evaluation of possible confounders including age, sex, cardiovascular risk factors, and number of significantly stenosed epicardial coronary arteries (b coefficient: 0.990, 95% confidence interval: 0.166-1.814, p = 0.019). Single-vessel coronary artery disease was more frequent in the group of HFpEF (HFrEF: 56% vs. HFmrEF: 64% vs. HFpEF: 73%, p = 0.049). PWV did not display any association with LVEF. Patients who presented MACE exhibited worse FMD values (4.51 ± 2.35% vs. 5.32 ± 2.67%, p = 0.02), and the highest tertile of galectin-3 was linked to more MACEs (36% vs. 5.9%, p = 0.01).
Flow-mediated dilatation displayed a linear improvement with LVEF in patients with ischemic HF. Deteriorated values are associated with MACE. Higher levels of galectin-3 might be used for risk stratification of patients with ischemic HF.
心力衰竭（HF）现在分为射血分数降低的心力衰竭（HFrEF）、射血分数轻度降低的心力衰竭（HFmrEF）和射血分数保留的心力衰竭（HFpEF）。内皮功能障碍（通过血流介导的扩张[FMD]评估）、动脉僵硬增加（通过颈动脉-股动脉脉搏波速度[PWV]评估）和半乳糖凝集素-3（一种心肌纤维化的生物标志物）与缺血性心力衰竭患者的主要不良心血管事件（MACE）有关。
本研究前瞻性纳入 340 例稳定型缺血性心力衰竭患者。我们评估了肱动脉 FMD、颈动脉-股动脉 PWV 和半乳糖凝集素-3 水平，并根据 HF 组对患者进行了 MACE 随访。
有趣的是，FMD 值根据左心室射血分数（LVEF）呈阶梯式改善（HFrEF：4.74±2.35% vs. HFmrEF：4.97±2.81% vs. HFpEF：5.94±3.46%，p=0.01），在评估包括年龄、性别、心血管危险因素和明显狭窄的心外膜冠状动脉数量等可能的混杂因素后，这种差异仍然显著（β系数：0.990，95%置信区间：0.166-1.814，p=0.019）。单支血管性冠状动脉疾病在 HFpEF 组更为常见（HFrEF：56% vs. HFmrEF：64% vs. HFpEF：73%，p=0.049）。PWV 与 LVEF 之间无关联。发生 MACE 的患者 FMD 值较差（4.51±2.35% vs. 5.32±2.67%，p=0.02），半乳糖凝集素-3 的最高三分位数与更多的 MACE 相关（36% vs. 5.9%，p=0.01）。
在缺血性心力衰竭患者中，血流介导的扩张与 LVEF 呈线性改善。值降低与 MACE 相关。较高的半乳糖凝集素-3 水平可能用于缺血性心力衰竭患者的风险分层。
