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Heart failure etiology affects peripheral vascular endothelial function after cardiac transplantation
A R Patel1, J T Kuvin, N G Pandian
1Cardiovascular Imaging and Hemodynamic Laboratory, New England Medical Center Hospitals Inc, Tufts University School of Medicine, Boston, Massachusetts 02111, USA.
Journal of the American College of Cardiology
|January 12, 2001
Summary
Cardiac transplantation restores vascular endothelial function in patients with nonischemic heart failure, but not in those with prior ischemic heart disease. Endothelial function remains impaired in heart failure patients regardless of cause.
Area of Science:
- Cardiology
- Vascular Biology
- Transplantation Medicine
Background:
- Peripheral vascular endothelial dysfunction is a hallmark of heart failure, irrespective of its cause (ischemic or nonischemic).
- The impact of heart failure etiology on endothelial function post-cardiac transplantation remains largely unexplored.
Purpose of the Study:
- To investigate how the original cause of heart failure influences peripheral vascular endothelial function in individuals who have received a cardiac transplant.
- To compare endothelial function in heart transplant recipients with different heart failure histories against heart failure patients and healthy controls.
Main Methods:
- Utilized brachial artery ultrasound to measure endothelium-dependent, flow-mediated dilation (FMD).
- Assessed FMD in four groups: heart failure patients (nonischemic and ischemic), cardiac transplant recipients (with prior nonischemic or ischemic cardiomyopathy), and a healthy control group.
Main Results:
- Heart failure patients, regardless of etiology, exhibited significantly impaired FMD compared to healthy controls.
- Cardiac transplant recipients with a history of nonischemic cardiomyopathy showed normal FMD, comparable to healthy controls.
- Transplant recipients with a history of ischemic cardiomyopathy demonstrated persistently impaired FMD, significantly lower than those with prior nonischemic cardiomyopathy.
Conclusions:
- Cardiac transplantation effectively normalizes peripheral vascular endothelial function in recipients whose heart failure stemmed from nonischemic causes.
- Endothelial function remains compromised in cardiac transplant recipients with a history of ischemic cardiomyopathy, suggesting incomplete recovery.
- These findings highlight the differential impact of heart failure etiology on post-transplant vascular health, differentiating between non-atherosclerotic and atherosclerotic origins.