Unit:
Faculty of MedicineLibrary of the School of Health Sciences
Dissertation committee:
Κλεάνθη Δήμα, Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Δημήτριος Τούσουλης, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Γεράσιμος Σιάσος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Εμμανουήλ Βαβουρανάκης, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Κωνσταντίνος Τσιούφης, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Κωνσταντίνα Αγγέλη, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Ευάγγελος Οικονόμου, Επίκουρος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Original Title:
Η συσχέτιση της ενδοθηλιακής λειτουργίας και της αρτηριακής σκληρίας με την πενταετή πρόγνωση των ασθενών με καρδιακή ανεπάρκεια με διατηρημένο (HFpEF), ενδιάμεσο (HFmrEF) και χαμηλό κλάσμα εξώθησης (HFrEF) που υπεβλήθησαν σε αγγειοπλαστική των στεφανιαίων αγγείων
Translated title:
Association between endothelial function and arterial stiffness with 5-year prognosis of patients with heart failure and preserved (HFpEF), mildly reduced (HFmrEF) and reduced (HFrEF) ejection fraction who underwent coronary angioplasty
Summary:
Introduction: Heart failure is a clinical syndrome attributed to numerous etiological factors and most commonly due to coronary artery disease. According to the most recent guidelines of European Society of Cardiology, heart failure is classified in heart failure with reduced ejection fraction (HFrEF), heart failure with mildly reduced ejection fraction (HFmrEF) and heart failure with preserved ejection fraction (HFpEF). Endothelial dysfunction and arterial stiffness are important mediators in the pathophysiology of heart failure and are associated with the pathways of in-flammation, fibrosis and myocardial remodeling due to the deleterious effects of risk factors. Prognosis of patients with heart failure is poor despite the advances in diagnosis and treatment mandating the need for a novel marker for risk stratification.
Purpose: The purpose of this study was to investigate the association of endothelial function and arterial stiffness with prognosis of patients with HFrEF, HFmrEF, and HFpEF who underwent coronary angioplasty. Circulating levels of galectin-3 and ST2 were also evaluated regarding patient prognosis.
Materials/Methods: We prospectively studied the association of brachial artery endothelium-dependent vasodilation (FMD), carotid-femoral pulse wave velocity (PWV), augmentation index corrected for heart rate (AIx-75), circulating biomarkers galectin-3 and ST2 (measured by ELISA) with the occurrence of cardiovascular events as a combined end-point (comprised by cardiovascular death, myocardial infarction, need for revascularization, stroke, hospitalization for heart failure and/or death, worsening of clinical stage of heart failure).
Results: Totally 340 patients were prospectively enrolled (26% HFrEF, 28% HFmrEF and 46% HFpEF, mean age 62±11 years, 63% males). Groups did not differ regarding clinical characteristics except for the more frequent occurrence of single-vessel coronary artery disease in HFpEF (HFrEF: 56% vs. HFmrEF: 64% vs. HFpEF: 73%, p=0.049), more frequent NYHA class I in HFpEF (HFrEF: 73.8% vs. HFmrEF: 77.5% vs. HFpEF: 95.6%, p=0.003) and more frequent NYHA class II and III in HFmrEF and HFrEF [NYHA II (HFrEF: 17.4% vs. HFmrEF: 22.3% vs. HFpEF: 4.4%, p=0.003), NYHA III (HFrEF: 8.7% vs. HFmrEF: 10.1% vs. HFpEF: 0%, p=0.003). FMD demonstrated a linear increase according to left ventricular ejection fraction (HFrEF: 4.74±2.35 vs. HFmrEF: 4.97±2.81 vs. HFpEF: 5.94±3.46, p=0.01). There were no differences in PWV, AIx-75, galectin-3 and ST2 levels between groups. After multivariate analysis, FMD was decreased in HFrEF compared to HFpEF by 1.0% (b coefficient: 0.990, 95% CI: 0.166-1.814, p=0.019) regardless of age, sex, risk factors and the number of narrowed coronary vessels. On the other hand, PWV and AIx-75 were not related to heart failure category. Patients were prospectively followed-up for 48 months (interquartile range: 36 to 76 months) and 38.2% experienced the combined end-point. There was no difference in the incidence of the combined end-point according to HF category (HFrEF: 38.2% vs. HFmrEF: 41.2% vs. HFpEF: 34.0%, p=0.24). FMD was diminuted in patients who experienced the combined end-point (4.51±2.35% vs. 5.32±2.67%, p=0.02), but PWV and AIx-75 did not differ between among patients with or without the combined end-point. Patients in the highest tertile of galectin-3 developed more events of the combined end-point during follow-up compared to the other quartiles (36% vs. 5.9%, p=0.01), but this finding was not evident for ST2.
Conclusions: Endothelial function assessed by FMD is lower in patients with HFrEF. Decreased values of FMD are linked to poorer prognosis of patients with HF and medical history of coronary angioplasty. Patients in the highest tertile of galectin-3 displayed more frequently cardiovascular events contrary to ST2.
Main subject category:
Health Sciences
Keywords:
Endothelial function, Arterial stiffness, Prognosis, Heart failure, Angioplasty
Number of references:
949
File:
File access is restricted until 2027-04-04.
Tsigkou_Vasiliki_PhD.pdf
2 MB
File access is restricted until 2027-04-04.
