Endothelial dysfunction, measured by reactive hyperaemia using strain-gauge plethysmography, is an independent predictor of adverse outcome in heart failure

Eur J Heart Fail. 2010 May;12(5):477-83. doi: 10.1093/eurjhf/hfq036. Epub 2010 Mar 30.


Aims: In congestive heart failure (CHF), arterial response is regulated by endothelial molecules. The aim of this study was to evaluate whether endothelial dysfunction (ED) was a predictor of outcome in a cohort of patients with heart failure.

Methods and results: Endothelial function was assessed in 242 patients with CHF by forearm reactive hyperaemia measured with intermittent venous occlusion plethysmography using a mercury strain gauge. The main endpoints were: 'total events' (death, heart attack, angina, stroke, NYHA class IV, or hospitalization due to heart failure) analysed using Cox regression for repeated events and 'death'. Patients were followed-up for 5 years. Post-hyperaemia forearm blood flow (PHFABF) was an independent predictor of total events [P = 0.01; hazard ratio [Exp(B)] 0.665, standard error (SE) 0.182]. Risk stratification by basal forearm blood flow (BFABF) showed that patients with basal blood flow above the median (3.03 mL min(-1) 100 mL(-1)) benefited from an increase in PHFABF, whereas in patients with a BFABF below the median, the increase in PHFABF did not diminish the risk of events. There was no relation between variations in PHFABF and death.

Conclusion: Post-hyperaemia forearm blood flow, as a measure of ED, is an independent predictor of major events in patients with CHF. A BFABF below the median is more predictive of an increased risk of complications.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cardiography, Impedance
  • Confidence Intervals
  • Endothelium, Vascular / pathology*
  • Female
  • Forearm / blood supply*
  • Health Status Indicators
  • Heart Failure / complications
  • Heart Failure / diagnosis*
  • Heart Failure / drug therapy
  • Heart Failure / mortality
  • Hemodynamics
  • Humans
  • Hyperemia / diagnosis*
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Prognosis
  • Proportional Hazards Models
  • Prospective Studies
  • Risk Assessment
  • Risk Factors
  • Statistics as Topic
  • Treatment Outcome