Evaluation of macrovascular morphofunctional changes in systolic heart failure

Introduction: Micro and macrovascular changes in heart failure represents a negative prognostic factor. Macrovascular disorders can be identified at early, asymptomatic levels by determining the ankle-brachi-al index. For the assessment of vascular stiffness, pulse wave velocity (PWV) is the most stable and reproduci-ble parameter.

Objective: Evaluation of macrovascular function and its correlations in systolic heart failure.

Methods: We conducted a prospective study in whi-ch we included 38 patients (31 men, 7 women, mean age 63 ± 12.9 years), with systolic heart failure, hae-modynamically stable. In all the patiens we performed routine tests (ECG, cardiac ultrasound, laboratory measurements) and for the assessment of macrovas-cular function the ankle-brachial arm index and the carotid intima-media thickness was measured, and the PWV was determined with the Mobil-O-Graph device. Depending on the PWV value, we included the pati-ents into two groups, group 1 with normal values and group 2 with elevated PWV values, then we studied the correlations according gender, age, left ventricular ejec-tion fraction and the presence of peripheral vascular disease.

Results: In 12 patients, the ankle-brachial index was below 0.9, 12 patients had ischemic heart failure, and 16 patients had elevated PWV (>10 m/s). The age was found to be a significant parameter in PWV increase (p<0.0001), with an average PWV of 8.55 ± 2.2 m/s, in patients over 65 years the PWV having the most sig-nificant increase (p<0.00001,10.85 m/s). PWV increase was more common in females (57.14%) than in males (35.48%), and was associated with ischemic heart failu-re. More decreased ejection fraction (<30%) was asso-ciated with more elevated PWV.

Conclusions: Macrovascular arterial dysfunction, in-creased vascular rigidity, have important correlations in systolic heart failure and could affect negatively the evolution and prognosis of disease.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)