2011


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2011/№3

Arterial stiffness and markers of endothelial dysfunction in the microcirculation of patients with CHF with preserved and reduced left ventricular systolic function

Osmolovskaya Yu. F., Mareev V. Y., Balakhonova T. V., Glechan A. M., Heymets G. I.

Keywords: arterial stiffness, left ventricle, microcirculation, contractile function, heart failure, endothelial dysfunction

DOI: 10.18087 / rhfj.2011.3.1505

Background. Such marker as pulse wave velocity (PWV) can be added to common risk factors of CHF. It is still unclear whether there is any relationship between diastolic / systolic heart failure and arterial stiffness (AS) as well as endothelial dysfunction in the microcirculation (EDMR). Objective. To identify the relationship between AS, marjers of EDMR and CHF with preserved (CHF-P) and decreased systolic function (CHF-D). Materials and methods. The study included 134 patients with CHF FC I–IV NYHA, with sinus rhythm and 30 patients without CHF (control group). Patients with CHF were divided into two subgroups: with EF <40 % (CHF-D, n=84), and with EF >45 % and proved diastolic dysfunction (CHF-P, n=50). Evaluation of vascular wall stiffness was performed with applanation tonometry (Sphygmocor): PWV on carotid-femoral area, mean arterial pressure (MAD), central pulse pressure (CPP), augmentation index (AI) in aorta. Endothelial function was assessed during reactive hyperemia by photopletismography with low cuff overlay. Clinical condition was assessed with 6‑minute walking test, Minnesota Quality of Life Questionnaire, SHOKS (by Mareev V. U.). All patients received recommended treatment for heart failure. Stepwise regression analysis was carried out to identify the factors of development of CHF-P and CHF-D. Results. The formula was created to calculate the probability of CHF-P and CHF-D. Markers of AS (PWV and AI) were significantly worse in patients with CHF-D compared with control group and patients with CHF-P. Increasing severity of CHF was assossiated with worse AS. PWV appears to be more informative indicator of AS. AS leads to increased intra-aortic resistance in patients with CHF-P, which manifestes in significantly higher value of CPP and IA. According to multiple correlation analysis, IA is the only marker of AS, reliably determining the presence of CHF-P. But no markers of AS were included in the list of indicators, determining CHF-D development.
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Osmolovskaya Yu. F., Mareev V. Y., Balakhonova T. V. et al. Arterial stiffness and markers of endothelial dysfunction in the microcirculation of patients with CHF with preserved and reduced left ventricular systolic function. Russian Heart Failure Journal. 2011;12(3):142-148

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