January 18, 2005Circulation
Vascular Endothelial Dysfunction and Mortality Risk in Patients With Chronic Heart Failure
Key result
Impaired flow-mediated dilation is linked to ~20% higher risk of death or urgent transplantation in CHF.
- HR 1.20
- 95% CI 1.03-1.45
- P=0.027
- n=259
Why the study?
The association between endothelial function and subsequent mortality risk in chronic heart failure had not been previously reported.
Does endothelial dysfunction (decreased FMD or exhaled NO) increase the risk of death or urgent transplantation in patients with NYHA class II-III chronic heart failure?
Population
259 subjects with NYHA class II-III chronic heart failure
Comparison
Decreased flow-mediated dilation or decreased exhaled nitric oxide production vs higher levels
Design
Prospective cohort study
Follow-up
Median 841 days (FMD group) and 396 days (exhaled NO group)
Authors
Discussion
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Implication
Endothelial dysfunction markers may refine prognostication in chronic HF; leaves open whether targeting them improves outcomes.
Key Points
- This research aims to investigate the relationship between endothelial dysfunction and mortality risk in chronic heart failure patients.
- Prospective assessment of endothelial function biomarkers in 259 subjects with New York Heart Association class II-III CHF.
- Measurement of flow-mediated dilation in the brachial artery and exhaled nitric oxide production during submaximal exercise.
- Cox multivariate proportional-hazards models used for analysis.
- Among subjects with FMD measurements (n=149), 12 deaths and 5 urgent transplantations occurred over a median follow-up of 841 days.
- Among subjects with exhaled NO production measurements (n=110), 18 deaths and 1 urgent transplantation occurred over a median follow-up of 396 days.
- Decreased FMD and exhaled NO production correlated with increased mortality risk after adjusting for other prognostic factors (adjusted HR for FMD=1.20, P=0.027; HR for exhaled NO=1.31, P=0.04).
Study Design
Type
Cohort (n=259)
Structured PICO
Does endothelial dysfunction (decreased FMD or exhaled NO) increase the risk of death or urgent transplantation in patients with NYHA class II-III chronic heart failure?
P
Population
259 subjects with New York Heart Association class II-III chronic heart failure, followed for a median of 396 to 841 days to assess endothelial function biomarkers.
E
Exposure
Decreased flow-mediated dilation (FMD) in the brachial artery or decreased exhaled nitric oxide (NO) production during submaximal exercise
O
Outcome
Death or urgent transplantationhard clinical
Main Result
Hazard Ratio: 1.2 (95% CI 1.03–1.45)
p-value: p=0.027
Endothelial dysfunction, measured by FMD or exhaled NO, is an independent predictor of increased mortality and urgent transplantation risk in patients with chronic heart failure.
Cite This Study
Katz et al. (2005) conducted a cohort in Chronic heart failure (n=259). Decreased flow-mediated dilation and exhaled nitric oxide production vs. Higher flow-mediated dilation and exhaled nitric oxide production was evaluated on Death or urgent transplantation (HR 1.20, 95% CI 1.03-1.45, p=0.027). Decreased flow-mediated dilation (HR 1.20 per 1% decrease) and exhaled NO production (HR 1.31 per 1-ppb/min decrease) were associated with increased risk of death or urgent transplantation in CHF.