- 作者：Isao Takishima ; Takamitsu Nakamura ; Mitsumasa Hirano ; Yoshinobu Kitta ; Tsuyoshi Kobayashi ; Daisuke Fujioka ; Yukio Saito ; Kazuhiro Watanabe ; Yosuke Watanabe ; Hideto Mishina ; Jyun-ei Obata ; Ken-ichi Kawabata ; Shun Tamaru ; Kiyotaka Kugiyama
- 关键词：Endothelium ; Prognosis ; Heart failure ; Risk factors ; Follow-up studies
- 刊名：International Journal of Cardiology
- 出版年：2012
- 出版时间：26 July, 2012
- 年：2012
- 卷：158
- 期：3
- 页码：417-422
- 全文大小：209 K
Background
It remains undefined whether reversibility of endothelial dysfunction after optimized therapies for heart failure (HF) provides prognostic information in patients with HF. This study examined whether changes in endothelial vasomotor function after therapies for HF may predict future outcomes in patients with stable HF.Methods
This study included 245 patients with stable chronic ischemic HF and an impaired flow-mediated dilation (FMD) of the brachial artery (FMD < 5.5 % ). Measurement of FMD was repeated after 6 months for individualized and optimized therapy for HF and atherosclerotic risk factors. Patients were followed for 36 months or until the occurrence of cardiac death or hospitalization with decompensated HF.
Results
FMD was persistently impaired (< 5.5 % ) in 130 (53 % ) patients after 6 months of the optimized therapy, whereas it improved (FMD ¡Ý 5.5 % ) in the remaining 115 (47 % ) patients. During follow-up, an event occurred in 26 (20 % ) patients with persistently impaired FMD and in 7 (6 % ) patients with improved FMD (p < 0.01). Multivariate Cox hazards analysis showed that persistent impairment of FMD was an independent predictor of cardiac events (hazard ratio 3.0, 95 % CI 1.3-6.9, p = 0.013). Persistently impaired FMD had a significantly incremental effect on the predictability of brain natriuretic peptide levels for cardiac events. Baseline FMD before the therapy for HF and atherosclerotic risk factors had no significant prognostic information.
Conclusions
Persistent endothelial vasomotor dysfunction despite therapies for HF and atherosclerotic risk factors was a predictor of cardiac events in patients with chronic ischemic HF.