Carotid-radial pulse wave velocity responses following hyperemia in patients with congestive heart failure

Carotid-radial pulse wave velocity (PWV) normally decreases following hyperemia and is an indicator of vasodilator reserve. This response is impaired in patients with congestive heart failure (CHF). To identify specific factors related to an impaired response, we studied 50 patients (60 ± 14 years, 67% male) with chronic CHF. Baseline PWV was measured using applanation tonometry and repeated 1 minute after release of upper arm occlusion for 5 minutes. Percentage changes (Δ) of PWV were normally distributed and mean ΔPWV was -2.2 ± 15.3%. On univariate analyses, ΔPWV correlated with New York Heart Association class, mean arterial pressure, log brain natriuretic peptide (BNP) levels, and baseline PWV, but not with left ventricular ejection fraction. Multivariate linear regression analysis demonstrated log BNP levels, mean arterial pressure, and baseline PWV (all P < .05) as independent predictors of ΔPWV. Hyperemia increased PWV in 42% of patients. On logistic regression, higher BNP levels and lower baseline PWV were independent predictors of a PWV increase. Higher BNP levels and lower baseline PWV are independent predictors of an abnormal hyperemic PWV response in patients with CHF. Higher BNP levels may reflect abnormal vasodilator reserve. Forty-two percent of heart failure patients showed an increase in PWV following hyperemia, which may reflect more severe arterial vasodilator impairment.