ENDOTHELIUM-DEPENDENT VASODILATATION IS NOT SELECTIVELY IMPAIRED IN PATIENTS WITH CHRONIC HEART-FAILURE SECONDARY TO VALVULAR HEART-DISEASEAND CONGENITAL HEART-DISEASE

This study examined possible selective impairment of endothelial dysfu nction in the peripheral vascular bed in patients with chronic heart f ailure in the absence of confounding factors influencing endothelial f unction (i.e. hypertension, hypercholesterolaemia and diabetes mellitu s). Several recent studies have suggested that endothelium-dependent p eripheral vasodilation is impaired but endothelium-independent vasodil ation is preserved in patients with chronic heart failure. However, a classical paper has demonstrated that sodium nitrite-mediated calf blo od flow is clearly depressed in patients with valvular heart disease a nd cardiomyopathy. We examined forearm blood flow changes mediated by acetylcholine and nitroprusside in patients with valvular heart diseas e (n=55) or congenital heart disease (n=13), and a comparison was made with healthy volunteers (n=21). The blood flow changes mediated by ac etylcholine and nitroprusside were significantly impaired in both pati ent groups (P<0.01). When blood flow responses were collected from all patients, two types of vasodilatory capacity were found to have decre ased significantly with increasing clinical severity of heart failure (New York Heart Association functional class; P<0.01). This suggests t hat the peripheral vasodilatory responses mediated by endothelium-depe ndent and endothelium-independent vasodilators are significantly impai red in patients with symptomatic chronic heart failure due to non-isch aemic heart disease.