Abnormalities of hemorheological, endothelial, and platelet function in patients with chronic heart failure in sinus rhythm - Effects of angiotensin-converting enzyme inhibitor and beta-blocker therapy

Background-To investigate the hypothesis that abnormalities of hemorheologi cal (fibrinogen, plasma viscosity), endothelial (von Willebrand factor [vWF ]), and platelet (soluble P-selectin) function would exist in patients with chronic heart failure (CHF) who are in sinus rhythm, we conducted a cross- sectional study of 120 patients with stable CHF (median ejection fraction 3 0%). We also hypothesized that ACE inhibitors and beta -blockers would bene ficially affect the measured indices. Methods and Results-In the cross-sectional analysis, plasma viscosity (P=0. 001), fibrinogen (P=0.02), VWF (P<0.0001), and soluble P-selectin (P<0.001) levels were elevated in patients with CHF compared with healthy controls. Women demonstrated greater abnormalities of hemorheological indices and vWF than males (all P<0.05). Plasma viscosity (P=0.009) and fibrinogen (P=0.00 14) levels were higher in patients with more severe symptoms (New York Hear t Association [NYHA] class III-IV), but there was no relationship with left ventricular ejection fraction. When ACE inhibitors were introduced, there was a reduction in fibrinogen (repeated-measures ANOVA, P=0.016) and vWF (P =0.006) levels compared with baseline. There were no significant changes in hemorheological, endothelial, or platelet markers after the introduction o f <beta>-blocker therapy, apart from a rise in mean platelet count (P<0.001 ). Conclusions-Abnormal levels of soluble P-selectin, vWF, and hemorheological indices may contribute to a hypercoagulable state in CHF, especially in fe male patients and in those with more severe NYHA class. Treatment with ACE inhibitors improved the prothrombotic state in CHF, whereas the addition of <beta>-blockers did trot. These positive effects of ACE inhibitors may off er an explanation for the observed reduction in ischemic events in clinical trials.