Blunted peripheral vasodilatory response is a hallmark of progressive deterioration in mild to moderate congestive heart failure

Citation
M. Nakamura et al., Blunted peripheral vasodilatory response is a hallmark of progressive deterioration in mild to moderate congestive heart failure, J CARD FAIL, 7(1), 2001, pp. 38-44
Citations number
26
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Cardiovascular & Respiratory Systems
Journal title
JOURNAL OF CARDIAC FAILURE
ISSN journal
1071-9164 → ACNP
Volume
7
Issue
1
Year of publication
2001
Pages
38 - 44
Database
ISI
SICI code
1071-9164(200103)7:1<38:BPVRIA>2.0.ZU;2-W
Abstract
Background: Several reports have shown that dilatory response to acetylchol ine (ACh) and nitroprusside (SNP) is blunted in the limb vasculature in pat ients with congestive heart failure (CHF). However, it is not yet known whe ther this vascular dysfunction is related to clinical outcome. We have exam ined the relationship between peripheral vasodilatory response and prognosi s of CHF. Methods and Results: A total of 46 patients with mild to moderate CHF were enrolled (mean age 56 years). Changes in forearm blood now (FBF) during int ra-arterial infusion of ACh and SNP were determined by plethysmography. FBF changes above baseline for each dose were cumulated and used as an index o f endothelium-dependent (ACh) response and endothelium-independent (SNP) re sponse, respectively. During the follow-up period (mean 32 months), 9 patie nts were admitted to the hospital for treatment of worsening refractory CHF , and 6 patients died suddenly or developed life-threatening arrhythmia. By Kaplan-Meier analysis, when all cardiac events were included, no significa nt differences were observed between any levels of vascular response in ter ms of prognosis. However, when deterioration events were analyzed separatel y, patients with SNP responses below the median (7.4 mL/min/dL) had signifi cantly higher rates of hospital admission caused by worsening CHF than thos e with above the median responses (P < .05). This relationship was not foun d between ACh response and clinical outcome. By Cox multivariate analysis, blunted vasodilatory response to SNP was a significant predictor of worseni ng CHF (<chi>(2) = 3.95: P < .05). Conclusion: This study has shown that patients with mild to moderate CHF sh owing a blunted vascular response to SNP rather than ACh were admitted to t he hospital more Frequently because of deterioration of CHF. This finding s uggests that changes in vascular smooth muscle and/or vascular structure in the peripheral vasculature may be a critical element in the worsening of C HF.