Heart failure etiology affects peripheral vascular endothelial function after cardiac transplantation

OBJECTIVES The goal of this study was to examine the effect of heart failur e etiology on peripheral vascular endothelial function in cardiac transplan t recipients. BACKGROUND Peripheral vascular endothelial dysfunction occurs in patients w ith heart failure of either ischemic or nonischemic etiology. The effect of heart failure etiology on peripheral endothelial function after cardiac tr ansplantation is unknown. METHODS Using brachial artery ultrasound, endothelium-dependent, flow-media ted dilation (FMD) was assessed in patients with heart failure with either nonischemic cardiomyopathy (n = 10) or ischemic cardiomyopathy (n = 7), car diac transplant recipients with prior nonischemic cardiomyopathy (n = 10) o r prior ischemic cardiomyopathy (n = 10) and normal controls (n = 10). RESULTS Patients with heart failure with either ischemic cardiomyopathy or nonischemic cardiomyopathy had impaired FMD (3.6 +/- 1.0% and 5.1 +/- 1.2%, respectively, p = NS) compared with normal subjects (13.9 +/- 1.3%, p < 0. 01 compared with either heart failure group). In transplant recipients with antecedent nonischemic cardiomyopathy, FMD was markedly higher than that o f heart failure patients with nonischemic cardiomyopathy (13.0 +/- 2.4%, p < 0.001) and similar to that of normal subjects (p = NS). However, FR ID re mained impaired in transplant recipients with prior ischemic cardiomyopathy (5.5 +/- 1.5%, p = 0.001 compared with normal, p = 0.002 vs, transplant rec ipients with previous nonischemic cardiomyopathy). CONCLUSIONS Peripheral vascular endothelial function is normal in cardiac t ransplant recipients with antecedent nonischemic cardiomyopathy, but remain s impaired in those with prior ischemic cardiomyopathy. In contrast, endoth elial function is uniformly abnormal for patients with heart failure, regar dless of etiology. These findings indicate that cardiac transplantation cor rects peripheral endothelial function for patients without ischemic heart d isease, but not in those with prior atherosclerotic coronary disease. (J Am Cell Cardiol 2001;37:195-200) (C) 2001 by the American College of Cardiolo gy.