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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.
  1. Mitchell GF, Parise H, Benjamin EJ et al. Changes in arterial stiffness and wave reflection with advancing age in healthy men and women: the Framingham Heart Study. Hypertension. 2004;43 (6):1239–1245.
  2. O’Rourke MF, Nichols WW. Aortic diameter, aortic stiffness, and wave reflection increase with age and isolated systolic hypertension. Hypertension. 2005;45 (4):652–658.
  3. Yambe M, Tomiyama H, Hirayama Y et al. Arterial stiffening as a possible risk factor for both atherosclerosis and diastolic heart failure. Hypertens Res. 2004;27 (9):625–631.
  4. Schram MT, Henry RM, van Dijk RA et al. Increased central artery stiffness in impaired glucose metabolism and type 2 diabetes: the Hoorn Study. Hypertension. 2004;43 (2):176–181.
  5. Wildman RP, Mackey RH, Bostom A et al. Measures of obesity are associated with vascular stiffness in young and older adults. Hypertension. 2003;42 (4):468–473.
  6. Blacher J, Safar ME, Pannier B et al. Prognostic significance of arterial stiffness measurements in end-stage renal disease patients. Curr Opin Nephrol Hypertens. 2002;11 (6):629–634.
  7. Safar ME, O’Rourke MF. Arterial stiffness in hypertension In: Handbook of Hypertension, Vol. 23. Amsterdam: Elsevier; 2006.
  8. Westerhof N, O’Rourke MF. Haemodynamic basis for the development of left ventricular failure in systolic hypertension and for its logical therapy. J Hypertens. 1995;13 (9):943–952.
  9. Arnold JM, Marchiori GE, Imrie JR et al. Large artery function in patients with chronic heart failure. Studies of brachial artery diameter and hemodynamics. Circulation. 1991;84 (6):2418–2425.
  10. Ooi H, Chung W, Biolo A. Arterial stiffness and vascular load in heart failure. Congest Heart Fail. 2008;14 (1):31–36.
  11. Wang M, Yip G, Yu CM et al. Independent and incremental prognostic va­lue of early mitral annulus velocity in patients with impaired left ventricular systolic function. J Am Coll Cardiol. 2005;45 (2):272–277.
  12. Nguyen JS, Lakkis NM, Bobek et al. Systolic and diastolic myocardial mechanics in patients with cardiac disease and preserved ejection fraction: impact of left ventricular filling pressure. J Am Soc Echocardiogr. 2010;23 (12):1273–1280.
  13. Zile MR, Bennett TD, St John Sutton M et al. Transition from chronic compensated to acute decompensated heart failure: pathophysiological insights obtained from continuous monitoring of intracardiac pressures. Circulation. 2008;118 (14):1433–1441.
  14. Zile MR, Brutsaert DL. New concepts in diastolic dysfunction and diastolic heart failure: Part II: causal mechanisms and treatment. Circulation. 2002;105 (12):1503–1508.
  15. Илюхин О. В., Илюхина М. В., Лопатин Ю. М. Прогностическая значимость скорости распространения пульсовой волны у больных хронической сердечной недостаточностью ишемической этиологии. Журнал Сердечная недостаточность. 2003;4 (3):145–147.
  16. Илюхина М. В. Эластические свойства и реактивность магистральных артерий у больных хронической сердечной недостаточностью. Автор. дисс. на соискание ученой степени к. м. н. – 2009.стр 18–21.
  17. Meguro T, Nagatomo Y, Nagae A et al. Elevated arterial stiffness evaluated by brachial-ankle pulse wave velocity is deleterious for the prognosis of patients with heart failure. Circ J. 2009;73 (4):673–680.
  18. Орлова Я. Н. Жесткость магистральных сосудов при ИБС: связь с атеросклерозом коронарных артерий, прогностическая значимость, возможности выявления и коррекции в амбулаторной практике. Автореф. дисс. на соискание ученой степени д. м. н. 2009.
  19. Balmain S, Padmanabhan N, Ferrell WR et al. Differences in arterial compliance, microvascular function and venous capacitance between patients with heart failure and either preserved or reduced left ventricular systolic function. Eur J Heart Fail. 2007;9 (9):865–871.
  20. Недогода С. В., Лопатин Ю. М., Чаляби Т. А., Марченко И. В. Изменения скорости распространения пульсовой волны при артериальной гипертензии. Южно-Российский Мед. журн. 2002;3:39–42.
  21. Лопатин Ю. М., Илюхин О. В., Илюхина М. В. и др. Эластичность артерий и скорость пульсовой волны у больных с хронической сердечной недостаточностью различной этиологии. Журнал Сердечная Недостаточность. 2004;5 (4):130–131.
  22. Agoşton-Coldea L, Mocan T, Bobar C. Arterial stiffness and left ventricular diastolic function in the patients with hypertension. Rom J Intern Med. 2008;46 (4):313–321.
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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