Vascular endothelial dysfunction and mortality risk in patients with chronic heart failure
Vascular endothelial dysfunction and mortality risk in patients with chronic heart failure
复制标题
DOI：
10.1161/01.cir.0000153349.77489.cf
复制
发表时间：
2005-01-25
期刊：
影响因子：
37.8
通讯作者：
Yasskiy, A
中科院分区：
文献类型：
--
作者：
Katz, SD;Hryniewicz, K;Yasskiy, A
背景 - 已知慢性心力衰竭 (CHF) 受试者的内皮功能受损，但之前尚未报道过内皮功能与 CHF 患者随后的死亡风险之间的关联。方法和结果 - 对纽约州 259 名受试者的体循环动脉循环（肱动脉血流介导的扩张 [FMD]）和肺循环（次最大运动期间呼出的一氧化氮 [NO] 产生）中内皮功能的生物标志物进行了前瞻性评估心脏协会 II-III 级 CHF。在进行 FMD 测量的受试者中（n = 149），在 841 天的中位随访期内，有 12 例死亡和 5 例紧急移植。在进行呼出一氧化氮生成测量的受试者中（n = 110），在中位随访期 396 天中，有 18 例死亡和 1 例紧急移植。在 Cox 多变量比例风险模型中调整其他已知 CHF 预后因素（年龄、CHF 病因、功能分级、左心室射血分数）后，FMD 减少和呼出一氧化氮生成减少均与死亡或紧急移植风险增加相关（FMD 减少 1% 的调整后风险比 [HR] 估计 = 1.20；95% 置信区间 [CI]，1.03 至 1.45；P = 0.027；呼出 NO 产生减少 1-ppb/min 时调整后的 HR 估计值 = 1.31，95% CI，1.01 至 1.69，P = 0.04）。 结论 - 根据肱动脉 FMD 和次最大运动期间呼出 NO 产生评估，CHF 患者的内皮功能障碍与缺血性和非缺血性 CHF 受试者的死亡风险增加相关。
Background - Endothelial function is known to be impaired in subjects with chronic heart failure (CHF), but the association between endothelial function and subsequent mortality risk in CHF has not been previously reported.Methods and Results - Biomarkers of endothelial function in the systemic arterial circulation ( flow-mediated dilation [FMD] in the brachial artery) and the pulmonary circulation ( exhaled nitric oxide [ NO] production during submaximal exercise) were prospectively assessed in 259 subjects with New York Heart Association class II - III CHF. In subjects with FMD measurements ( n = 149), there were 12 deaths and 5 urgent transplantations over a median follow-up period of 841 days. In subjects with exhaled NO production measurements ( n = 110), there were 18 deaths and 1 urgent transplantation over a median follow-up period of 396 days. Both decreased FMD and decreased exhaled NO production were associated with increased risk of death or urgent transplantation after adjustment for other known CHF prognostic factors ( age, etiology of CHF, functional class, left ventricular ejection fraction) in Cox multivariate proportional-hazards models ( adjusted hazard ratio [HR] estimate for a 1% decrease in FMD = 1.20; 95% confidence interval [CI], 1.03 to 1.45; P = 0.027; adjusted HR estimate for a 1-ppb/min decrease in exhaled NO production = 1.31, 95% CI, 1.01 to 1.69, P = 0.04).Conclusions - Endothelial dysfunction in CHF, as assessed by FMD in the brachial artery and exhaled NO production during submaximal exercise, is associated with an increased mortality risk in subjects with both ischemic and nonischemic CHF.