Impact of vascular endothelial function on comorbid chronic kidney disease in patients with non-ischemic heart failure

Background：Vascular endothelial dysfunction plays a role on pathophysiology of heart failure (HF) and chronic kidney disease (CKD), both of which are often comorbid. However, there have been no previous reports, where the vascular endothelial function was assessed focusing on comorbid CKD in the HF, especially non-ischemic HF. Methods：We assessed vascular endothelial function using simultaneous procedure of flow-mediated dilatation (FMD) and reactive hyperemia-peripheral arterial tonometry (RH-PAT) in 33 consecutive patients with non-ischemic HF. Results：The FMD value was lower in HF patients with comorbid CKD (CKD group; n=18) than in the remaining patients without CKD (non-CKD group; n=15) (4.37±1.89 vs 6.31±3.42, P=0.048). The value of reactive hyperemia index (RHI) measured by RH-PAT was also lower in the CKD group than in the non-CKD group (1.65±0.46 vs 2.24±0.65, P=0.004). Even after adjustment for confounding factors, which showed intra-group difference, the significant differences in both values of FMD (P=0.005) and RHI (P=0.003) still remained between CKD and non-CKD groups. Conclusions：Vascular endothelial function might be impaired more strongly in non-ischemic HF patients with comorbid CKD, compared with those without CKD. The impaired endothelial function might be associated with prevalence of CKD in patients with non-ischemic HF.