Impaired endothelium-mediated vasodilation in the peripheral vasculature of patients with congestive heart failure

Department of Medicine, Albert Einstein College of Medicine, Bronx, New York 10461.

Impaired endothelial-dependent vasodilation has been demonstrated in two animal models of congestive heart failure and in the coronary circulation of patients with idiopathic dilated cardiomyopathy. To determine whether this impairment contributes to the abnormal peripheral vasomotor tone in patients with congestive heart failure, the local vascular response to intraarterial infusions of graded concentrations (10(-8) M to 10(-5) M) of acetylcholine (an endothelial-dependent vasodilator) and nitroglycerin (a direct-acting vasodilator) was studied in the superficial femoral artery of 19 patients with congestive heart failure (New York Heart Association classes I to IV) and 6 age-matched normal control subjects. The local vascular response was determined from the arterial blood flow velocity pattern obtained by transcutaneous Doppler ultrasonography. Acetylcholine, 10(-5) M, induced a pattern characteristic of vasodilation in all six normal subjects; mean blood flow velocity for the group significantly increased from 11.9 +/- 2.7 to 44.8 +/- 20.9 cm/s (p less than 0.05). In contrast, the same dose of acetylcholine induced a blood flow velocity pattern characteristic of vasodilation in only 4 of the 19 patients with congestive heart failure. Group mean blood flow velocity did not change significantly. Nitroglycerin, 10(-7) M, induced vasodilation in all 6 normal subjects but in only 1 of 19 patients. Nitroglycerin, 10(-5) M, was administered to 10 patients; all 10 demonstrated a pattern characteristic of vasodilation. Thus, acetylcholine-mediated endothelial-dependent vasodilation appears to be impaired in the peripheral vasculature of patients with congestive heart failure. Both endothelial dysfunction and abnormal vascular smooth muscle responsiveness may contribute to abnormal peripheral vasomotor tone.

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				A. Maiorana, G. O'Driscoll, L. Dembo, C. Cheetham, C. Goodman, R. Taylor, and D. Green Effect of aerobic and resistance exercise training on vascular function in heart failure Am J Physiol Heart Circ Physiol, October 1, 2000; 279(4): H1999 - H2005. [Abstract] [Full Text] [PDF]

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				C. E. Negrao, M. A. Hamilton, G. C. Fonarow, A. Hage, J. D. Moriguchi, and H. R. Middlekauff Impaired endothelium-mediated vasodilation is not the principal cause of vasoconstriction in heart failure Am J Physiol Heart Circ Physiol, January 1, 2000; 278(1): H168 - H174. [Abstract] [Full Text] [PDF]

				L. Comini, T. Bachetti, L. Agnoletti, G. Gaia, S. Curello, B. Milanesi, M. Volterrani, G. Parrinello, C. Ceconi, A. Giordano, et al. Induction of functional inducible nitric oxide synthase in monocytes of patients with congestive heart failure. Link with tumour necrosis factor-{alpha} Eur. Heart J., October 2, 1999; 20(20): 1503 - 1513. [Abstract] [PDF]

				G. Kojda and D. Harrison Interactions between NO and reactive oxygen species: pathophysiological importance in atherosclerosis, hypertension, diabetes and heart failure Cardiovasc Res, August 15, 1999; 43(3): 652 - 671. [Full Text] [PDF]

				J. Bauersachs, A. Bouloumie, D. Fraccarollo, K. Hu, R. Busse, and G. Ertl Endothelial Dysfunction in Chronic Myocardial Infarction Despite Increased Vascular Endothelial Nitric Oxide Synthase and Soluble Guanylate Cyclase Expression : Role of Enhanced Vascular Superoxide Production Circulation, July 20, 1999; 100(3): 292 - 298. [Abstract] [Full Text] [PDF]

				R. Varin, P. Mulder, V. Richard, F. Tamion, C. Devaux, J.-P. Henry, F. Lallemand, G. Lerebours, and C. Thuillez Exercise Improves Flow-Mediated Vasodilatation of Skeletal Muscle Arteries in Rats With Chronic Heart Failure : Role of Nitric Oxide, Prostanoids, and Oxidant Stress Circulation, June 8, 1999; 99(22): 2951 - 2957. [Abstract] [Full Text] [PDF]

				S. Yasuda, Y. Goto, H. Sumida, T. Noguchi, T. Baba, S. Miyazaki, and H. Nonogi Angiotensin-Converting Enzyme Inhibition Restores Hepatocyte Growth Factor Production in Patients With Congestive Heart Failure Hypertension, June 1, 1999; 33(6): 1374 - 1378. [Abstract] [Full Text] [PDF]

				Y Kanaya, M Nakamura, N Kobayashi, and K Hiramori Effects of L-arginine on lower limb vasodilator reserve and exercise capacity in patients with chronic heart failure Heart, May 1, 1999; 81(5): 512 - 517. [Abstract] [Full Text]

				M.-H. Zou, M. Leist, and V. Ullrich Selective Nitration of Prostacyclin Synthase and Defective Vasorelaxation in Atherosclerotic Bovine Coronary Arteries Am. J. Pathol., May 1, 1999; 154(5): 1359 - 1365. [Abstract] [Full Text] [PDF]

				W. Johnson, C. Lucas, L. W. Stevenson, and M. A. Creager Effect of intensive therapy for heart failure on the vasodilator response to exercise J. Am. Coll. Cardiol., March 1, 1999; 33(3): 743 - 749. [Abstract] [Full Text] [PDF]

				M. B. Patel, I. V. Kaplan, R. N. Patni, D. Levy, J. A. Strom, J. Shirani, and T. H. LeJemtel Sustained Improvement in Flow-Mediated Vasodilation After Short-Term Administration of Dobutamine in Patients With Severe Congestive Heart Failure Circulation, January 12, 1999; 99(1): 60 - 64. [Abstract] [Full Text] [PDF]

				R. Hambrecht, E. Fiehn, C. Weigl, S. Gielen, C. Hamann, R. Kaiser, J. Yu, V. Adams, J. Niebauer, and G. Schuler Regular Physical Exercise Corrects Endothelial Dysfunction and Improves Exercise Capacity in Patients With Chronic Heart Failure Circulation, December 15, 1998; 98(24): 2709 - 2715. [Abstract] [Full Text] [PDF]

				A. Cooper and A. M. Heagerty Endothelial dysfunction in human intramyocardial small arteries in atherosclerosis and hypercholesterolemia Am J Physiol Heart Circ Physiol, October 1, 1998; 275(4): H1482 - H1488. [Abstract] [Full Text] [PDF]

				S M Maguire, A G Nugent, C McGurk, G D Johnston, and D P Nicholls Abnormal vascular responses in human chronic cardiac failure are both endothelium dependent and endothelium independent Heart, August 1, 1998; 80(2): 141 - 145. [Abstract] [Full Text]

				M. A. Mathier, G. A. Rose, M. A. Fifer, M. I. Miyamoto, R. E. Dinsmore, H. H. Castano, G. W. Dec, I. F. Palacios, and M. J. Semigran Coronary endothelial dysfunction in patients with acute-onset idiopathic dilated cardiomyopathy J. Am. Coll. Cardiol., July 1, 1998; 32(1): 216 - 224. [Abstract] [Full Text] [PDF]

				N. Stephens, M. J. Drinkhill, A. S. Hall, S. G. Ball, and A. M. Heagerty Structure and in vitro function of human subcutaneous small arteries in mild heart failure Am J Physiol Cell Physiol, May 1, 1998; 274(5): C1298 - C1305. [Abstract] [Full Text] [PDF]

				S. Husain, N. P. Andrews, D. Mulcahy, J. A. Panza, and A. A. Quyyumi Aspirin Improves Endothelial Dysfunction in Atherosclerosis Circulation, March 3, 1998; 97(8): 716 - 720. [Abstract] [Full Text] [PDF]

				J. Wang, G.-H. Yi, M. Knecht, B.-l. Cai, S. Poposkis, M. Packer, and D. Burkhoff Physical Training Alters the Pathogenesis of Pacing-Induced Heart Failure Through Endothelium-Mediated Mechanisms in Awake Dogs Circulation, October 21, 1997; 96(8): 2683 - 2692. [Abstract] [Full Text]

				S. D. Katz, J. Yuen, R. Bijou, and T. H. Lejemtel Training improves endothelium-dependent vasodilation in resistance vessels of patients with heart failure J Appl Physiol, May 1, 1997; 82(5): 1488 - 1492. [Abstract] [Full Text] [PDF]

				J. N. Cohn Is There a Role for Endothelin in the Natural History of Heart Failure? Circulation, August 15, 1996; 94(4): 604 - 606. [Full Text]

				T. S. Rector, A. J. Bank, K. A. Mullen, L. K. Tschumperlin, R. Sih, K. Pillai, and S. H. Kubo Randomized, Double-Blind, Placebo-Controlled Study of Supplemental Oral L-Arginine in Patients With Heart Failure Circulation, June 15, 1996; 93(12): 2135 - 2141. [Abstract] [Full Text]

				M.W. Ramsey, J. Goodfellow, C.J.H. Jones, L.A. Luddington, M.J. Lewis, and A.H. Henderson Endothelial Control of Arterial Distensibility Is Impaired in Chronic Heart Failure Circulation, December 1, 1995; 92(11): 3212 - 3219. [Abstract] [Full Text]

				M. M.H. Marijianowski, M. van Laar, J. Bras, and A. E. Becker Chronic Congestive Heart Failure Is Associated With a Phenotypic Shift of Intramyocardial Endothelial Cells Circulation, September 15, 1995; 92(6): 1494 - 1498. [Abstract] [Full Text]

				A.B. Bridges, M. McLaren, and J.J.F. Belch A Comparative Study of Captopril and Enalapril on Endothelial Cell Function in Congestive Heart Failure Patients Angiology, September 1, 1995; 46(9): 811 - 817. [Abstract] [PDF]

				D. B. Haitsma, D. Merkus, J. Vermeulen, P. D. Verdouw, and D. J. Duncker Nitric oxide production is maintained in exercising swine with chronic left ventricular dysfunction Am J Physiol Heart Circ Physiol, June 1, 2002; 282(6): H2198 - H2209. [Abstract] [Full Text] [PDF]