Is vascular remodelling in patients with chronic heart failure exaggerated?

Abstract

Vascular remodelling of large arteries increases afterload of the left ventricle. The aim of this study was to analyse whether vascular remodelling and function under laboratory and 24-hour ambulatory conditions is impaired in patients with chronic heart failure (CHF) independently of cardiovascular risk factors. In this monocentric cross-sectional observational study, 105 patients with CHF and an ejection fraction ≤49% (CHF+) were compared to 118 subjects without CHF (CHF-). After adjustment for age, gender, arterial hypertension, hyperlipidaemia, type 2 diabetes, obesity and smoking, vascular function and structure parameters, as assessed by pulse wave analysis (SphygmoCor) and the UNEX EF device, respectively, between the CHF+ and the CHF- group differed for resting pulse wave velocity (PWV) (P=0.010), 24-h ambulatory PWV (P=0.011), central systolic blood pressure (cSBP) (P=<0.001), 24-h ambulatory cSBP (P=<0.001), resting central augmentation index (P=0.002), and brachial intima-media thickness (P=0.022). In CHF+ patients, higher levels of NT-proBNP, taken as a marker for the severity of CHF, were related to a higher PWV (r=0.340, P=<0.001), a higher cSBP (r=0.292, P=0.005), and a trend to higher central pulse pressure (cPP) (r=0.198, P=0.058), higher 24-h brachial PP (r=0.322, P=0.002), and 24-h total peripheral resistance (s=0.227, P=0.041) after full adjustment for covariates. In CHF+ patients we observed augmented vascular remodelling and functional impairment compared with CHF- patients independently of cardiovascular risk factors, age, and gender, and the extent of vascular remodelling and impairment was related to the severity of CHF.