Flow-mediated dilation normalization predicts outcome in chronic heart failure patients

Franco Tarro Genta, Ermanno Eleuteri, Pier Luigi Temporelli, Fabio Comazzi, Massimo Tidu, Zoia Bouslenko, Francesca Bertolin, Carlo Vigorito, Pantaleo Giannuzzi, Francesco Giallauria

Research output: Contribution to journalArticlepeer-review


Background: Reduced flow-mediated dilation (FMD) is a known prognostic marker in heart failure (HF), but may be influenced by the brachial artery (BA) diameter. Aiming to adjust for this influence, we normalized FMD (nFMD) by the peak shear rate (PSR) and tested its prognostic power in HF patients. Methods and Results: BA diameter, FMD, difference in hyperemic versus rest brachial flow velocity (FVD), PSR (FVD/BA), and nFMD (FMD/PSR × 1000) were assessed in 71 HF patients. At follow-up (mean 512 days), 19 HF (27%) reached the combined endpoint (4 heart transplantations [HTs], 1 left ventricle assist device implantation [LVAD], and 14 cardiac deaths [CDs]). With multivariate Cox regression analysis, New York Heart Association functional class ≥III (hazard ratio [HR] 9.36, 95% confidence interval [CI] 2.11-41.4; P =.003), digoxin use (HR 6.36, 95% CI 2.18-18.6; P =.0010), FMD (HR 0.703, 95% CI 0.547-0.904; P =.006), PSR (HR 1.01, 95% CI 1.005-1.022; P =.001), FVD (HR 1.04, 95% CI 1.00-1.06; P =.02), and nFMD (HR 0.535, 95% CI 0.39-0.74; P =.0001) were predictors of unfavorable outcome. Receiver operating characteristic curve for nFMD showed that patients with nFMD >5 seconds had significantly better event-free survival than patients with nFMD ≤5 seconds (log-rank test: P 5 seconds have a better prognosis than those with lower values.

Original languageEnglish
Pages (from-to)260-267
Number of pages8
JournalJournal of Cardiac Failure
Issue number4
Publication statusPublished - Apr 2013


  • brachial artery
  • Endothelial function
  • flow-mediated dilation
  • heart failure
  • shear rate

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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