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CLINICAL STUDY: HEART FAILURE

Radial, carotid and aortic distensibility in congestive heart failure: effects of high-dose angiotensin-converting enzyme inhibitor or low-dose association with angiotensin type 1 receptor blockade

Cristina Giannattasio, MD, PhD^*, Felice Achilli, MD, Monica Failla, MD^*, Anna Capra, MD^*, Antonella Vincenzi, MD, Franco Valagussa, MD and Giuseppe Mancia, MD^*,*

^* Clinica Medica, Department of Medicina Clinica, Prevenzione e Biotecnologie Sanitarie, Milano-Bicocca University, Milano, Italy
Divisione di Cardiologia, S. Gerardo Hospital, Monza, Italy
IRCCS Istituto Auxologico, Milano, Italy

Manuscript received May 31, 2001; revised manuscript received January 14, 2002, accepted January 28, 2002.

^* Reprint requests and correspondence: Dr. Giuseppe Mancia, Clinica Medica, Ospedale San Gerardo, Via Donizetti 106, 20052, Monza, Italy.
giuseppe.mancia{at}unimib.it

OBJECTIVES: The aim of this study was to determine whether in patients with congestive heart failure (CHF) a distensibility (Dist) reduction: 1) similarly occurs in different arteries; 2) is related to CHF severity; and 3) is reversible with treatment.

BACKGROUND: Several studies suggest that CHF is accompanied by a reduced arterial Dist.

METHODS: We measured diameter in radial artery, carotid artery (CA) and abdominal aorta (AO) by echotracking. Distensibility was obtained by relating it to blood pressure. Data were collected in 30 patients with CHF (New York Heart Association functional class I to III) under standard treatment with diuretic, digitalis and angiotensin-converting enzyme (ACE) inhibitor in whom CHF severity was assessed by maximum oxygen consumption (VO₂max) percentage and in 30 age- and gender-matched controls. Patients with CHF were then randomized to maintain standard treatment (n = 10), double the ACE inhibitor dose (n = 10) or add an angiotensin II antagonist (n = 10) and restudied after two months.

RESULTS: Distensibility was markedly reduced in the CHF group in all three vessels (p < 0.01), CA and AO Dist being related to CHF severity (p < 0.05). After two months, Dist did not change in the group maintained under standard treatment, but it increased significantly (p < 0.05) and similarly when the ACE inhibitor dose was doubled or an angiotensin II antagonist was added.

CONCLUSIONS: Congestive heart failure is characterized by a reduction of Dist of large-elastic and middle-sized muscular arteries. The reduction of large-elastic artery Dist is related to the CHF severity. These alterations can be reversed by drugs, effectively interfering with the renin-angiotensin system either at the ACE or at the angiotensin receptor level.

Abbreviations and Acronyms   ACE   angiotensin-converting enzyme   ANOVA   analysis of variance   AO   abdominal aorta   BP   blood pressure   CA   carotid artery   CHF   congestive heart failure   Dd   diastolic diameter   Dist   distensibility   Ds   systolic diameter   E/A   ratio between early and atrial transmitral peak flow   RA   radial artery   VO2   volume of oxygen consumption   VO2max   maximum oxygen consumption   WT   wall thickness

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