Circulation, Vol 84, 2418-2425, Copyright © 1991 by American Heart Association
JM Arnold, GE Marchiori, JR Imrie, GL Burton, PW Pflugfelder and WJ Kostuk
BACKGROUND. Although progressive chronic congestive heart failure (CHF) is
associated with elevated systemic vascular resistance and increased
impedance to ventricular outflow, the contribution of changes in large
artery function has not been well documented in humans. METHODS AND
RESULTS. We studied 45 patients with a broad range of clinical severity of
CHF and compared noninvasive measurements of brachial artery diameter,
flow, and pulse wave velocity with 22 normal controls of similar age. In
CHF, mean arterial pressure was lower than in controls (85 +/- 1 versus 93
+/- 2 mm Hg, p less than 0.001), as were brachial artery diameter (4.07 +/-
0.10 versus 4.53 +/- 0.09 mm, p less than 0.001), flow (40.9 +/- 4.1 versus
70.9 +/- 11.5 ml.min-1, p less than 0.02), compliance (1.29 +/- 0.12 versus
2.00 +/- 0.18 cm4.dyne-1.10(- 7), p less than 0.002), and conductance (0.49
+/- 0.05 versus 0.76 +/- 0.13 units, p = 0.06). Limb vascular resistance
(40.2 +/- 5.0 versus 20.5 +/- 3.1 units, p less than 0.001) and pulse wave
velocity (10.6 +/- 0.5 versus 9.2 +/- 0.4 m.sec-1, p less than 0.03) were
higher than in controls. Brachial artery diameter was progressively lower
than in controls as severity of CHF increased (New York Heart Association
class II, 4.47 +/- 0.23 mm, p = NS; class III, 4.05 +/- 0.10 mm, p less
than 0.05; class IV, 3.71 +/- 0.28 mm, p less than 0.05). Similar changes
were observed for arterial compliance (class II, 1.76 +/- 0.32 cm4.dyne-
1.10(-7), p = NS; class III, 1.21 +/- 0.13 cm4.dyne-1.10(-7), p less than
0.05; class IV, 0.95 +/- 0.10 cm4.dyne-1.10(-7), p less than 0.05). While
the lower arterial pressure and flow might be expected to passively reduce
arterial diameter, this would be associated with a reduced pulse wave
velocity and improved arterial compliance, yet the opposite was observed.
Differences in large artery function were not likely caused by underlying
atherosclerosis alone, because patients with dilated cardiomyopathy and
patients with ischemic heart disease of the same sex, age, left ventricular
ejection fraction, and exercise treadmill duration had similar changes in
large artery function. CONCLUSIONS. We conclude that alterations in
brachial artery function are present in patients with moderate and severe
CHF. The observed reduction in arterial compliance, if present diffusely
throughout the arterial tree, could increase left ventricular end-systolic
stress directly and through increased velocity of reflected pressure waves
from the periphery.
ARTICLES
Large artery function in patients with chronic heart failure. Studies of brachial artery diameter and hemodynamics
Division of Cardiology, Victoria Hospital, London, Ontario, Canada.
This article has been cited by other articles:
 |
|
 |
|
  S. L. Curtis, A. Zambanini, J. Mayet, S. A. McG Thom, R. Foale, K. H. Parker, and A. D. Hughes Reduced systolic wave generation and increased peripheral wave reflection in chronic heart failure Am J Physiol Heart Circ Physiol, July 1, 2007; 293(1): H557 - H562. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A.-Y. Chong, A.D. Blann, and G.Y.H. Lip Assessment of endothelial damage and dysfunction: observations in relation to heart failure QJM, April 1, 2003; 96(4): 253 - 267. [Full Text] [PDF]
|
|
|
|
 |
|
 S. Bonapace, A. Rossi, M. Cicoira, L. Franceschini, G. Golia, L. Zanolla, P. Marino, and P. Zardini Aortic Distensibility Independently Affects Exercise Tolerance in Patients With Dilated Cardiomyopathy Circulation, April 1, 2003; 107(12): 1603 - 1608. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. G. Lage, L. Kopel, C. C. J. Medeiros, R. T. Carvalho, and M. A. Creager Angiotensin II contributes to arterial compliance in congestive heart failure Am J Physiol Heart Circ Physiol, October 1, 2002; 283(4): H1424 - H1429. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Giannattasio, F. Achilli, M. Failla, A. Capra, A. Vincenzi, F. Valagussa, and G. Mancia Radial, carotid and aortic distensibility in congestive heart failure: effects of high-dose angiotensin-converting enzyme inhibitor or low-dose association with angiotensin type 1 receptor blockade J. Am. Coll. Cardiol., April 17, 2002; 39(8): 1275 - 1282. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Joannides, C. Bizet-Nafeh, A. Costentin, M. Iacob, G. Derumeaux, A. Cribier, and C. Thuillez Chronic ACE Inhibition Enhances the Endothelial Control of Arterial Mechanics and Flow-Dependent Vasodilatation in Heart Failure Hypertension, December 1, 2001; 38(6): 1446 - 1450. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J. Domanski, B. R. Davis, M. A. Pfeffer, M. Kastantin, and G. F. Mitchell Isolated Systolic Hypertension : Prognostic Information Provided by Pulse Pressure Hypertension, September 1, 1999; 34(3): 375 - 380. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J. Domanski, G. F. Mitchell, J. E. Norman, D. V. Exner, B. Pitt, and M. A. Pfeffer Independent prognostic information provided by sphygmomanometrically determined pulse pressure and mean arterial pressure in patients with left ventricular dysfunction J. Am. Coll. Cardiol., March 15, 1999; 33(4): 951 - 958. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Hornig, N. Arakawa, C. Kohler, and H. Drexler Vitamin C Improves Endothelial Function of Conduit Arteries in Patients With Chronic Heart Failure Circulation, February 3, 1998; 97(4): 363 - 368. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Isnard, P. Lechat, H. Kalotka, H. Chikr, S. Fitoussi, J. Salloum, J.-L. Golmard, D. Thomas, and M. Komajda Muscular blood flow response to submaximal leg exercise in normal subjects and in patients with heart failure J Appl Physiol, December 1, 1996; 81(6): 2571 - 2579. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Annane, E. Bellissant, E. Pussard, R. Asmar, F. Lacombe, E. Lanata, O. Madonna, M. Safar, J.-F. Giudicelli, and P. Gajdos Placebo-Controlled, Randomized, Double-Blind Study of Intravenous Enalaprilat Efficacy and Safety in Acute Cardiogenic Pulmonary Edema Circulation, September 15, 1996; 94(6): 1316 - 1324. [Abstract] [Full Text]
|
|
|
|
|
|
T. S. Rector, A. J. Bank, K. A. Mullen, L. K. Tschumperlin, R. Sih, K. Pillai, and S. H. Kubo Randomized, Double-Blind, Placebo-Controlled Study of Supplemental Oral L-Arginine in Patients With Heart Failure Circulation, June 15, 1996; 93(12): 2135 - 2141. [Abstract] [Full Text]
|
|
|
|
|
|
B. Hornig, V. Maier, and H. Drexler Physical Training Improves Endothelial Function in Patients With Chronic Heart Failure Circulation, January 15, 1996; 93(2): 210 - 214. [Abstract] [Full Text]
|
|
|
|
 |
|
 A. J. Bank, R. F. Wilson, S. H. Kubo, J. E. Holte, T. J. Dresing, and H. Wang Direct Effects of Smooth Muscle Relaxation and Contraction on In Vivo Human Brachial Artery Elastic Properties Circ. Res., November 1, 1995; 77(5): 1008 - 1016. [Abstract] [Full Text]
|
|
|
|
 |
|
 S. Heeneman, P. J. A. Leenders, P. J. J. W. Aarts, J. F. M. Smits, J. W. Arends, and M. J. A. P. Daemen Peripheral Vascular Alterations During Experimental Heart Failure in the Rat : Do They Exist? Arterioscler. Thromb. Vasc. Biol., September 1, 1995; 15(9): 1503 - 1511. [Abstract] [Full Text]
|
|
|
|
|
|
C. Giannattasio, M. Failla, M. L. Stella, A. A. Mangoni, D. Turrini, S. Carugo, M. Pozzi, G. Grassi, and G. Mancia Angiotensin-Converting Enzyme Inhibition and Radial Artery Compliance in Patients With Congestive Heart Failure Hypertension, September 1, 1995; 26(3): 491 - 496. [Abstract] [Full Text]
|
|
|
|
|
|
G. Grassi, C. Giannattasio, M. Failla, A. Pesenti, G. Peretti, E. Marinoni, N. Fraschini, S. Vailati, and G. Mancia Sympathetic Modulation of Radial Artery Compliance in Congestive Heart Failure Hypertension, August 1, 1995; 26(2): 348 - 354. [Abstract] [Full Text]
|
|
|
|
|
|
S. Y. Wang, D. E. Manyari, N. Scott-Douglas, O. A. Smiseth, E. R. Smith, and J. V. Tyberg Splanchnic Venous Pressure–Volume Relation During Experimental Acute Ischemic Heart Failure : Differential Effects of Hydralazine, Enalaprilat, and Nitroglycerin Circulation, February 15, 1995; 91(4): 1205 - 1212. [Abstract] [Full Text]
|
|