Reactive hyperemia is associated with adverse clinical outcomes in heart failure

© 2016 Elsevier Inc. All rights reserved. Introduction Impaired endothelial function, as assessed by brachial artery flow-mediated dilation (FMD), is an established risk factor for cardiovascular events. FMD is impaired in heart failure (HF) patients, but less is known about hyperemic brachial artery flow. We investigated the relationship between FMD and hyperemic flow with adverse clinical outcomes in HF patients. Methods Brachial artery FMD and hyperemic flow were assessed in 156 patients (70.5 % Male; 45.5% Caucasian; mean age (± SD) = 56.2 (±12.4) years) with HF and reduced left ventricular ejection fraction (LVEF). Cox proportional hazard models were used to assess the potential explanatory association of FMD and hyperemic flow with the composite outcome of death or cardiovascular hospitalization over a median 5-year follow-up period. Results Both FMD and hyperemic flow were negatively correlated with age, but unrelated to sex, race, body mass index, LVEF or N-terminal pro-B-Type natriuretic peptide (NT-ProBNP). Reduced hyperemic flow, but not FMD, was associated with an increased risk of death or cardiac hospitalization after controlling for traditional risk factors. Conclusion The association of reduced hyperemic flow with increased risk of adverse clinical outcomes suggests that micro-vascular function may be an important prognostic marker in patients with HF

Blood pressure reactivity to psychological stress is associated with clinical outcomes in patients with heart failure

© 2017 Elsevier Inc. Introduction: Cardiovascular (CV) reactivity to psychological stress has been implicated in the development and exacerbation of cardiovascular disease (CVD). Although high CV reactivity traditionally is thought to convey greater risk of CVD, the relationship between reactivity and clinical outcomes is inconsistent and may depend on the patient population under investigation. The present study examined CV reactivity in patients with heart failure (HF) and its potential association with long-term clinical outcomes. Methods: One hundred ninety-nine outpatients diagnosed with HF, with ejection fraction ≤40%, underwent an evaluation of blood pressure (BP) and heart rate reactivity to a laboratory-based simulated public-speaking stressor. Cox proportional hazards regression models were used to examine the prospective association between BP and heart rate reactivity on a combined end point of death or CV hospitalization over a 5-year median follow-up period. Results: Both systolic blood pressure (SBP) and diastolic blood pressure (DBP) reactivity, quantified as continuous variables, were inversely related to risk of death or CV hospitalization (Ps < .01) after controlling for established risk factors, including HF disease severity and etiology. In similar models, heart rate reactivity was unrelated to outcome (P = .12). In models with tertiles of reactivity, high SBP reactivity, compared with intermediate SBP reactivity, was associated with lower risk (hazard ratio [HR] = .498, 95% CI .335-.742, P =.001), whereas low SBP reactivity did not differ from intermediate reactivity. For DBP, high reactivity was marginally associated with lower risk compared with intermediate DBP reactivity (HR = .767, 95% CI .515-1.14, P =.193), whereas low DBP reactivity was associated with greater risk (HR = 1.49, 95% CI 1.027-2.155, P =.0359). No relationship of heart rate reactivity to outcome was identified. Conclusions: For HF patients with reduced ejection fraction, a robust increase in BP evoked by a laboratory-based psychological challenge was associated with lower risk for adverse CVD events and may be a novel and unique marker of left ventricular systolic reserve that is accompanied by a more favorable long-term prognosis

Inhaled endotoxin induces a systemic neutrophil response without affecting cardiovascular measures in a randomized cross-over exposure study

The gram-negative bacterial cell wall component endotoxin (lipopolysaccharide, LPS) is a key component of particulate matter (PM). PM exposure is associated with cardiovascular morbidity and mortality. However, the contribution of individual components of PM to acute and chronic cardiovascular measures is not clear. This study examines whether systemic inflammation induced by LPS inhalation causes acute changes in cardiovascular physiology measures. In this double blinded, placebo-controlled crossover study, fifteen adult volunteers underwent inhalation exposure to 20,000 EU Clinical Center Reference Endotoxin (CCRE). Peripheral blood and induced sputum neutrophils were obtained at baseline and six hours post-exposure. Blood pressure, measures of left ventricular function (ejection fraction (LVEF) and global longitudinal strain (LVGLS)), and indices of endothelial function (flow mediated dilation (FMD) and velocity time integral during hyperemia (VTIhyp)) were measured before and after treatment. Wilcoxon sign-rank tests and linear mixed models were used for statistical analysis. In comparison with normal saline, LPS inhalation resulted in significant increases in peripheral blood and sputum neutrophils but was not associated with significant alterations in blood pressure, LVGLS, LVEF, FMD, or VTIhyp. In healthy adults, systemic inflammation after LPS inhalation was not associated with acute changes in cardiovascular physiology. Larger studies are needed to investigate the effects of other PM components on inflammation induced cardiovascular dysfunction.</p

Distribution of Flow-Mediated Dilation by Albuminuria Categories: FMD is lowest in patients with severely increased albuminuria compared with those with moderately increased and normal albuminuria, although the difference is not statistically significant (p = 0.16).

<p>Distribution of Flow-Mediated Dilation by Albuminuria Categories: FMD is lowest in patients with severely increased albuminuria compared with those with moderately increased and normal albuminuria, although the difference is not statistically significant (p = 0.16).</p

Scatter Plot and Regression Line Between Spot Urine Albumin-Creatinine Ratio and Urine Aliquot for Albumin-Creatinine Ratio: Urine albumin-creatinine ratio assessed by spot albumin-creatinine ratio is strongly correlated with urine aliquots for albumin-creatinine ratio obtained from the 24-hour urine collection (ρ = 0.97; 95% CI: 0.92–0.99, p < 0.0001).

<p>Scatter Plot and Regression Line Between Spot Urine Albumin-Creatinine Ratio and Urine Aliquot for Albumin-Creatinine Ratio: Urine albumin-creatinine ratio assessed by spot albumin-creatinine ratio is strongly correlated with urine aliquots for albumin-creatinine ratio obtained from the 24-hour urine collection (ρ = 0.97; 95% CI: 0.92–0.99, p < 0.0001).</p

Levels of Biological Variables Based on Albuminuria Category.

<p>Levels of Biological Variables Based on Albuminuria Category.</p

Spearman Correlation of Urine Albumin-Creatinine Ratio with Biological Variables.

<p>Spearman Correlation of Urine Albumin-Creatinine Ratio with Biological Variables.</p

Values of Measures of Endothelial Function Based on Albuminuria Category.

<p>Values of Measures of Endothelial Function Based on Albuminuria Category.</p

Scatter Plot and Regression Line Between Flow-Mediated Dilation and Albuminuria in Sickle Cell Anemia: Urine albumin-creatinine ratio is significantly correlated with FMD (ρ = -0.45; 95% CI: -0.72 –-0.04, p = 0.031).

<p>Scatter Plot and Regression Line Between Flow-Mediated Dilation and Albuminuria in Sickle Cell Anemia: Urine albumin-creatinine ratio is significantly correlated with FMD (ρ = -0.45; 95% CI: -0.72 –-0.04, p = 0.031).</p

Spearman Correlation of Flow Mediated Dilation with Biological Variables.

<p>Spearman Correlation of Flow Mediated Dilation with Biological Variables.</p