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 Scopus citations


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
Issue number3
StatePublished - Mar 2010
Externally publishedYes



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

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this