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European Heart Journal Advance Access originally published online on November 23, 2004
European Heart Journal 2005 26(1):65-69; doi:10.1093/eurheartj/ehi001
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European Heart Journal (2005) 26, 65-69
© The European Society of Cardiology 2005

Endothelial dysfunction in patients with chronic heart failure is independently associated with increased incidence of hospitalization, cardiac transplantation, or death

D. Fischer, S. Rossa, U. Landmesser, S. Spiekermann, N. Engberding, B. Hornig and H. Drexler*

Abteilung Kardiologie und Angiologie, Medizinische Hochschule Hannover, Carl Neuberg Str. 1, 30625 Hannover, Germany

Received 7 July 2004; revised 8 October 2004; accepted 14 October 2004 ; online publish-ahead-of-print 23 November 2004 .

* Corresponding author. Tel: +49-511-532 3840; fax: +49-511-532 5412. E-mail address: drexler.helmut{at}mh-hannover.de

Background Endothelial dysfunction of coronary and peripheral arteries has been demonstrated in patients with chronic heart failure (CHF) and appears to be associated with functional implications. However, it is unknown whether endothelial dysfunction in CHF is independently associated with impaired outcome or progression of the disease.

Methods and results We assessed the follow-up of 67 consecutive patients with CHF [New York Heart Association (NYHA) functional class II–III] in which flow-dependent, endothelium-mediated vasodilation (FDD) of the radial artery was assessed by high resolution ultrasound. The primary endpoint was defined by cardiac death, hospitalization due to worsening of heart failure (NYHA class IV, pulmonary oedema), or heart transplantation. Cox regression analysis was used to determine whether FDD was associated with these heart failure-related events. During a median follow-up of 45.7 months 24 patients had an event: 18 patients were hospitalized due to worsening of heart failure or heart transplantation, six patients died for cardiac reasons. Cox regression analysis demonstrated that FDD (P<0.01), diabetes mellitus (P<0.01), and ejection fraction (P<0.01) were independent predictive factors for the occurrence of the primary endpoint. The Kaplan–Meier survival curve revealed a significantly better clinical outcome in patients with FDD above the median (6.2%) compared with those with FDD below the median (P<0.013).

Conclusion These observations suggest that endothelium-mediated vasodilation represents an independent predictor of cardiac death and hospitalization in patients with CHF, consistent with the notion that endothelium-derived nitric oxide may play a protective role in heart failure.

Key Words: Heart failure • Endothelial function


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