CLINICAL STUDY: HEART TRANSPLANT
Heart failure etiology affects peripheral vascular endothelial function after cardiac transplantation
Ayan R. Patel, MD*,
Jeffrey T. Kuvin, MD*,
Natesa G. Pandian, MD, FACC*,
John J. Smith, MD, PhD, FACC* ,
James E. Udelson, MD, FACC* ,
Michael E. Mendelsohn, MD, FACC ,
Marvin A. Konstam, MD, FACC* and
Richard H. Karas, MD, PhD, FACC
* Cardiovascular Imaging and Hemodynamic Laboratory, New England Medical Center Hospitals Inc., Tufts University School of Medicine, Boston, Massachusetts, USA
Molecular Cardiology Research Institute, Division of Cardiology, Department of Medicine, New England Medical Center Hospitals Inc., Tufts University School of Medicine, Boston, Massachusetts, USA
Manuscript received March 17, 2000;
revised manuscript received July 21, 2000,
accepted September 13, 2000.
Reprint requests and correspondence: Dr. Richard H. Karas, Molecular Cardiology Research Institute, New England Medical Center, 750 Washington Street, Box 80, Boston, Massachusetts 02111 rkaras{at}lifespan.org
OBJECTIVES
The goal of this study was to examine the effect of heart failure etiology on peripheral vascular endothelial function in cardiac transplant recipients.
BACKGROUND
Peripheral vascular endothelial dysfunction occurs in patients with heart failure of either ischemic or nonischemic etiology. The effect of heart failure etiology on peripheral endothelial function after cardiac transplantation is unknown.
METHODS
Using brachial artery ultrasound, endothelium-dependent, flow-mediated dilation (FMD) was assessed in patients with heart failure with either nonischemic cardiomyopathy (n = 10) or ischemic cardiomyopathy (n = 7), cardiac transplant recipients with prior nonischemic cardiomyopathy (n = 10) or prior ischemic cardiomyopathy (n = 10) and normal controls (n = 10).
RESULTS
Patients with heart failure with either ischemic cardiomyopathy or nonischemic cardiomyopathy had impaired FMD (3.6 ± 1.0% and 5.1 ± 1.2%, respectively, p = NS) compared with normal subjects (13.9 ± 1.3%, p < 0.01 compared with either heart failure group). In transplant recipients with antecedent nonischemic cardiomyopathy, FMD was markedly higher than that of heart failure patients with nonischemic cardiomyopathy (13.0 ± 2.4%, p < 0.001) and similar to that of normal subjects (p = NS). However, FMD remained impaired in transplant recipients with prior ischemic cardiomyopathy (5.5 ± 1.5%, p = 0.001 compared with normal, p = 0.002 vs. transplant recipients with previous nonischemic cardiomyopathy).
CONCLUSIONS
Peripheral vascular endothelial function is normal in cardiac transplant recipients with antecedent nonischemic cardiomyopathy, but remains impaired in those with prior ischemic cardiomyopathy. In contrast, endothelial function is uniformly abnormal for patients with heart failure, regardless of etiology. These findings indicate that cardiac transplantation corrects peripheral endothelial function for patients without ischemic heart disease, but not in those with prior atherosclerotic coronary disease.
|
Abbreviations and Acronyms
| | ACE | = angiotensin-converting enzyme | | FMD | = flow-mediated dilatation | | LVEF | = left ventricular ejection fraction | | NYHA | = New York Heart Association |
|
This article has been cited by other articles:

|
 |

|
 |
 
M. Klosinska, T. Rudzinski, P. Grzelak, L. Stefanczyk, J. Drozdz, and M. Krzeminska-Pakula
Endothelium-dependent and -independent vasodilation is more attenuated in ischaemic than in non-ischaemic heart failure
Eur J Heart Fail,
August 1, 2009;
11(8):
765 - 770.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
M. L. Bots, J. Westerink, T. J. Rabelink, and E. J.P. de Koning
Assessment of flow-mediated vasodilatation (FMD) of the brachial artery: effects of technical aspects of the FMD measurement on the FMD response
Eur. Heart J.,
February 2, 2005;
26(4):
363 - 368.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
A.-Y. Chong, A.D. Blann, and G.Y.H. Lip
Assessment of endothelial damage and dysfunction: observations in relation to heart failure
QJM,
April 1, 2003;
96(4):
253 - 267.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
J. T. Kuvin, A. R. Patel, K. A. Sliney, N. G. Pandian, W. M. Rand, J. E. Udelson, and R. H. Karas
Peripheral vascular endothelial function testing as a noninvasive indicator of coronary artery disease
J. Am. Coll. Cardiol.,
December 1, 2001;
38(7):
1843 - 1849.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
C. Giannattasio, F. Achilli, A. Grappiolo, M. Failla, E. Meles, G. Gentile, I. Calchera, A. Capra, J. Baglivo, A. Vincenzi, et al.
Radial Artery Flow-Mediated Dilatation in Heart Failure Patients: Effects of Pharmacological and Nonpharmacological Treatment
Hypertension,
December 1, 2001;
38(6):
1451 - 1455.
[Abstract]
[Full Text]
[PDF]
|
 |
|
|