Endothelium-Dependent and -Independent Vasodilation is More Attenuated in Ischaemic than in Non-Ischaemic Heart Failure

AIMS: Endothelial dysfunction in chronic heart failure (CHF) contributes to vasoconstriction. Underlying atherosclerosis may increase vascular abnormalities in ischaemic CHF. We aimed to compare flow-mediated dilation (FMD) and nitroglycerin-mediated dilation (NMD) of the brachial artery between patients with ischaemic and non-ischaemic CHF. METHODS AND RESULTS: A total of 57 patients with systolic CHF participated in the study (mean age 59 +/- 8 years, 81% male). Patients were in stable NYHA class II (40 patients, 70%) and III (17 patients, 30%). Ischaemic aetiology of CHF was confirmed by coronary angiography in 34 (60%) patients and ruled out in 23 (40%). Flow-mediated dilation and NMD of the brachial artery was assessed by high-resolution ultrasound. Endothelium-dependent vasodilation was markedly reduced in patients with ischaemic CHF compared with those with non-ischaemic aetiology of CHF-mean absolute change in artery diameter (Deltad) 0.09 +/- 0.07 mm in ischaemic group vs. 0.18 +/- 0.07 mm in non-ischaemic (P < 0.0001). Nitroglycerin-mediated vasodilation was also significantly different-Deltad = 0.14 +/- 0.06 mm in ischaemic vs. 0.31 +/- 0.10 mm in non-ischaemic CHF (P < 0.0001). CONCLUSION: Endothelium-dependent and -independent vascular response is more attenuated in ischaemic than in non-ischaemic CHF.