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This Article Full Text Full Text (PDF) All Versions of this Article: 292/3/H1427    most recent 00567.2006v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (2) Citing Articles via Google Scholar Google Scholar Articles by Hundley, W. G. Articles by Kitzman, D. W. Search for Related Content PubMed PubMed Citation Articles by Hundley, W. G. Articles by Kitzman, D. W.

Leg flow-mediated arterial dilation in elderly patients with heart failure and normal left ventricular ejection fraction

Departments of ¹Internal Medicine (Cardiology Section), ²Biomedical Engineering, ⁴Radiology, and ³Public Health Sciences, The Wake Forest University School of Medicine, Winston-Salem, North Carolina

Submitted 1 June 2006 ; accepted in final form 23 October 2006

Background: flow-mediated arterial dilation (FMAD), an indicator of endothelial function, is reduced in patients with heart failure and reduced left ventricular ejection fraction (HFREF). Many elderly patients with heart failure exhibit a normal left ventricular ejection fraction (HFNEF). It is unknown whether FMAD is severely reduced in the elderly with HFNEF. Methods and Results: 30 participants >60 yr of age, 11 healthy, 9 with HFNEF, and 10 with HFREF, underwent a cardiovascular magnetic resonance (CMR) assessment of FMAD in the superficial femoral artery followed within 48 h by symptom-limited exercise with expired gas analysis. Elderly patients with HFREF and HFNEF had severely reduced peak oxygen consumption (O_{2 peak}; 12 ± 2 and 13 ± 1 ml·kg^–1·min^–1, respectively) vs. their healthy age-matched contemporaries (20 ± 3 ml·kg^–1·min^–1). FMAD was 3.8 ± 1.3% (0.85 ± 0.22 mm²) in patients with HFREF; it was 12.1 ± 3.6% (3.1 ± 1.2 mm²) and 13.7 ± 5.9% (3.9 ± 1.7 mm²), respectively, in patients with HFNEF and age-matched healthy older individuals. After adjustment for age and gender, the association of FMAD with O₂ was high in healthy and HFREF subjects (P = 0.05 and 0.02, respectively) but less so in HFNEF participants (P = 0.58). Conclusions: elderly patients with HFNEF do not exhibit marked reduction in leg FMAD. These data suggest that mechanisms other than impaired femoral arterial endothelial function contribute to the severe exercise intolerance experienced by these individuals.

endothelial function; magnetic resonance imaging

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