Association between endothelial function and chronotropic incompetence in subjects with chronic heart failure receiving optimal medical therapy

Timothy J. Vittorio, Gregg Lanier, Ronald Zolty, Nitasha Sarswat, Chi Hong Tseng, Paolo C. Colombo, Ulrich P. Jorde

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Objective: Impairment of flow-mediated, endothelium-dependent vasodilatation (FMD) of the brachial artery identifies peripheral endothelial dysfunction in subjects with chronic congestive heart failure (CHF) and is associated with increased morbidity and mortality. To further elucidate the interaction of peripheral and central mechanisms in the syndrome of CHF, we examined the association between endothelial function and chronotropic incompetence, an emerging prognostic marker in CHF. Methods: Thirty subjects with stable New York Heart Association (NYHA) functional class II-III CHF were studied. A vascular ultrasound study was performed to measure brachial artery FMD. The percentage of age-adjusted maximal predicted heart rate (MPHR) reached during cardiopulmonary exercise tolerance testing (CPETT) was used to assess the degree of chronotropic competence. All patients received ACE inhibitors and β-adrenoceptor blockers. Results: Brachial artery FMD averaged 1.3 ± 2.4% and age-adjusted % MPHR 74.1 ± 11.7%. FMD correlated with % MPHR among all patients (r = 0.60, P = 0.01). FMD and resting heart rate (RHR) did not significantly correlate (r = 0.13, P = 0.55). Conclusions: FMD, a measure of peripheral endothelial dysfunction, and % MPHR, a central determinant of cardiac output, are moderately correlated in heart failure patients receiving optimal medical therapy. Whether a cause-effect relationship underlies this association remains to be investigated.

Original languageEnglish (US)
Pages (from-to)294-299
Number of pages6
JournalEchocardiography
Volume27
Issue number3
DOIs
StatePublished - 2010
Externally publishedYes

Fingerprint

Heart Failure
Heart Rate
Brachial Artery
Therapeutics
Exercise Tolerance
Angiotensin-Converting Enzyme Inhibitors
Vasodilation
Cardiac Output
Mental Competency
Adrenergic Receptors
Endothelium
Blood Vessels
Morbidity
Mortality

Keywords

  • Brachial artery
  • Chronotropic incompetence
  • Dilated cardiomyopathy
  • Flow-mediated dilatation
  • Heart failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging
  • Medicine(all)

Cite this

Association between endothelial function and chronotropic incompetence in subjects with chronic heart failure receiving optimal medical therapy. / Vittorio, Timothy J.; Lanier, Gregg; Zolty, Ronald; Sarswat, Nitasha; Tseng, Chi Hong; Colombo, Paolo C.; Jorde, Ulrich P.

In: Echocardiography, Vol. 27, No. 3, 2010, p. 294-299.

Research output: Contribution to journalArticle

Vittorio, Timothy J. ; Lanier, Gregg ; Zolty, Ronald ; Sarswat, Nitasha ; Tseng, Chi Hong ; Colombo, Paolo C. ; Jorde, Ulrich P. / Association between endothelial function and chronotropic incompetence in subjects with chronic heart failure receiving optimal medical therapy. In: Echocardiography. 2010 ; Vol. 27, No. 3. pp. 294-299.
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AU - Jorde, Ulrich P.

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N2 - Objective: Impairment of flow-mediated, endothelium-dependent vasodilatation (FMD) of the brachial artery identifies peripheral endothelial dysfunction in subjects with chronic congestive heart failure (CHF) and is associated with increased morbidity and mortality. To further elucidate the interaction of peripheral and central mechanisms in the syndrome of CHF, we examined the association between endothelial function and chronotropic incompetence, an emerging prognostic marker in CHF. Methods: Thirty subjects with stable New York Heart Association (NYHA) functional class II-III CHF were studied. A vascular ultrasound study was performed to measure brachial artery FMD. The percentage of age-adjusted maximal predicted heart rate (MPHR) reached during cardiopulmonary exercise tolerance testing (CPETT) was used to assess the degree of chronotropic competence. All patients received ACE inhibitors and β-adrenoceptor blockers. Results: Brachial artery FMD averaged 1.3 ± 2.4% and age-adjusted % MPHR 74.1 ± 11.7%. FMD correlated with % MPHR among all patients (r = 0.60, P = 0.01). FMD and resting heart rate (RHR) did not significantly correlate (r = 0.13, P = 0.55). Conclusions: FMD, a measure of peripheral endothelial dysfunction, and % MPHR, a central determinant of cardiac output, are moderately correlated in heart failure patients receiving optimal medical therapy. Whether a cause-effect relationship underlies this association remains to be investigated.

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