Abstract
The purpose of this study was to evaluate whether heart failure with mildly reduced ejection fraction (HFmrEF) is associated with vascular dysfunction and whether vascular function predicts future deterioration of LVEF in patients with HFmrEF. We evaluated endothelial function assessed by flow-mediated vasodilation (FMD) and vascular smooth muscle function assessed by nitroglycerine-induced vasodilation (NID) in 69 patients with HFmrEF and 426 patients without HF and evaluated the future deterioration of LVEF, defined as a decrease in LVEF to <40%, in 39 patients with HFmrEF for up to 3 years. Both FMD and NID were significantly lower in patients with HFmrEF than in patients without HF. We categorized patients into two groups based on low tertiles of NID: a low group (NID of <7.0%) and an intermediate and high group (NID of ≥7.0%). There were significant differences between the Kaplan–Meier curves for the deterioration of LVEF in the two groups (p < 0.01). Multivariate Cox proportional hazard analysis revealed that NID of <7.0% was an independent predictor of future deterioration of LVEF in patients with HFmrEF. Both endothelial function and vascular smooth muscle function are impaired in patients with HFmrEF compared with those in patients without HF. In addition, low NID of <7.0% predicts future deterioration of LVEF.
Highlights
The mortality rate of patients with heart failure with mildly reduced ejection fraction (HFmrEF) is comparable to that of patients with HF with reduced ejection fraction (HFrEF) and that of HF patients with preserved ejection fraction (HFpEF) [1,2]
There was no significant difference in brachial intima-media thickness (IMT) (0.32 ± 0.09 mm versus 0.32 ± 0.09 mm, p = 0.77; Figure 1C) and brachial–ankle pulse wave velocity (baPWV) (1648 ± 372 cm/s versus 1705 ± 459 cm/s, p = 0.34; Figure 1D) between patients without HF and patients with HFmrEF
Model 5: adjusted for age, sex, and being a current smoker. We showed that both endothelial function assessed by flow-mediated vasodilation (FMD) and vascular smooth muscle function assessed by nitroglycerine-induced vasodilation (NID) were impaired in patients with HFmrEF compared with those in patients without HF, and we showed by using propensity score matching analysis that vascular smooth muscle function was impaired in patients with HFmrEF compared with that in control subjects
Summary
The mortality rate of patients with heart failure with mildly reduced ejection fraction (HFmrEF) is comparable to that of patients with HF with reduced ejection fraction (HFrEF) and that of HF patients with preserved ejection fraction (HFpEF) [1,2]. Previous studies have clearly shown that vascular dysfunction plays an important role in the pathogenesis and maintenance of HF including HFrEF and HFpEF [3,4,5,6,7]. Both patients with HFrEF and patients with HFpEF had vascular dysfunction compared with patients without HF [5,6]. Deterioration of LVEF in patients with HFmrEF increases mortality and/or HF hospitalization [9]. It is clinically important to predict future deterioration of LVEF in patients with HFmrEF. There are few predictors for deterioration of LVEF in patients with HFmrEF [10,11,12], there is no established predictor for deterioration of LVEF
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