Venous Endothelial Function in Heart Failure: Comparison with Healthy Controls and Effect of Clinical Compensation

BACKGROUND: Endothelial function has been extensively evaluated at the arterial bed in several cardiovascular scenarios. Venous endothelial dysfunction, however, has not been thoroughly explored particularly in heart failure (HF). AIMS: To characterize venous endothelial function in severe HF. METHODS AND RESULTS: Venous endothelial function was evaluated by the dorsal hand vein technique using a tripod holding a linear variable differential transformer. Dorsal hand veins were pre-constricted with phenylephrine and dose-response curves were constructed after acetylcholine and sodium nitroprusside administration. Maximum vasodilator response to acetylcholine, a marker of endothelium-dependent venodilation, was significantly lower (47+/-53% versus 102+/-54%, respectively, p=0.0004) in HF (n=27) patients compared to healthy controls (n=20). No difference in the endothelium-independent venodilator response was observed (p=0.87). Maximum vasodilator response to acetylcholine was also significantly lower on admission compared to the response immediately before hospital discharge in patients with acute decompensated HF (p<0.01). Improvement in venous endothelial function paralleled weight loss (mean difference of -3.8 kg, p<0.01) and improvement in the 6-minute walk test (mean difference of 107 m, p<0.01). There was no significant change in angiotensin-converting enzyme inhibitor or beta-blocker use during hospital stay. CONCLUSIONS: HF patients experience marked endothelium-dependent venous dysfunction with partial recovery during in-hospital management.