What does this research mean for the field?

Q: What does this research mean for the field?

Impaired vascular endothelial function, measured by brachial flow-mediated dilation, independently predicts increased mortality and adverse cardiovascular events in patients with advanced ischemic chronic heart failure. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

April 30, 2009European Journal of Heart Failure

Vascular Endothelial Function Predicts Mortality Risk in Patients with Advanced Ischaemic Chronic Heart Failure

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Why the study?

Does impaired flow-mediated dilation predict adverse cardiovascular events and mortality in patients with advanced ischaemic chronic heart failure?

Structured PICO

Does impaired flow-mediated dilation predict adverse cardiovascular events and mortality in patients with advanced ischaemic chronic heart failure?

Population

82 consecutive patients with advanced ischaemic chronic heart failure (NYHA class IV), mean LVEF 22 +/- 3%.

Intervention

Brachial flow-mediated dilation (FMD) lesser than or equal to the median of 4.6%

Comparator

Brachial flow-mediated dilation (FMD) above the median of 4.6%

Outcome

Composite of adverse cardiovascular events, including death, hospitalization for CHF exacerbation, or myocardial infarctioncomposite

Impaired endothelial function, as measured by brachial flow-mediated dilation, is an independent predictor of mortality and adverse cardiovascular events in patients with advanced ischemic heart failure.

Implication

May aid risk stratification in advanced ischemic HF; leaves open whether FMD-targeted interventions improve outcomes.

Abstract

AIMS: Endothelial function is impaired in advanced chronic heart failure (ACHF) patients. We explored a possible association between endothelial function and subsequent mortality risk in ACHF. METHODS AND RESULTS: We prospectively assessed brachial flow-mediated dilation (FMD) in 82 consecutive New York Heart Association class IV ischaemic ACHF patients with a mean left ventricular ejection fraction (LVEF) of 22 +/- 3%. Following overnight fasting and discontinuation of all medications for > or = 12 h, percent increase in FMD (%FMD) and nitroglycerin-mediated vasodilation were assessed using linear array ultrasound. All patients were followed for 14 +/- 2 months for adverse cardiovascular events, including death, hospitalization for CHF exacerbation, or myocardial infarction. Patients were divided into two groups: those with an FMD lesser than or equal to the median %FMD of 4.6% (n = 41) and those with an FMD above the median (n = 41). Both groups were comparable regarding cardiovascular risk factors, LVEF, and concomitant medications. During follow-up, 22 (53.6%) patients with FMD lesser than or equal to the median had composite adverse cardiovascular events compared with only eight patients (19.5%) with FMD above the median (P < 0.01). Furthermore, fiver deaths (12.1%) occurred in patients with FMD lesser than or equal to the median, compared with no deaths in patients with FMD above the median (P < 0.03). Cox regression analyses revealed that FMD was an independent predictor for these events. CONCLUSION: Flow-mediated dilation is associated with increased mortality risk in ischaemic ACHF patients.