Loughborough University
paine et al 2016 PMC version.pdf (129.71 kB)

Reactive hyperemia is associated with adverse clinical outcomes in heart failure

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posted on 2017-10-31, 14:35 authored by Nicola PaineNicola Paine, Alan L. Hinderliter, James A. Blumenthal, Kirkwood F. Adams, Carla A. Sueta, Patricia P. Chang, Christopher M. O'Connor, Andrew Sherwood
© 2016 Elsevier Inc. All rights reserved. Introduction Impaired endothelial function, as assessed by brachial artery flow-mediated dilation (FMD), is an established risk factor for cardiovascular events. FMD is impaired in heart failure (HF) patients, but less is known about hyperemic brachial artery flow. We investigated the relationship between FMD and hyperemic flow with adverse clinical outcomes in HF patients. Methods Brachial artery FMD and hyperemic flow were assessed in 156 patients (70.5 % Male; 45.5% Caucasian; mean age (± SD) = 56.2 (±12.4) years) with HF and reduced left ventricular ejection fraction (LVEF). Cox proportional hazard models were used to assess the potential explanatory association of FMD and hyperemic flow with the composite outcome of death or cardiovascular hospitalization over a median 5-year follow-up period. Results Both FMD and hyperemic flow were negatively correlated with age, but unrelated to sex, race, body mass index, LVEF or N-terminal pro-B-Type natriuretic peptide (NT-ProBNP). Reduced hyperemic flow, but not FMD, was associated with an increased risk of death or cardiac hospitalization after controlling for traditional risk factors. Conclusion The association of reduced hyperemic flow with increased risk of adverse clinical outcomes suggests that micro-vascular function may be an important prognostic marker in patients with HF.


This work was supported by grant HL61784 from the National Heart, Lung, and Blood Institute and grant M01-RR-30 from the General Clinical Research Center program, National Center for Research Resources, National Institutes of Health.



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Published in

American Heart Journal




108 - 114


PAINE, N.J. ...et al., 2016. Reactive hyperemia is associated with adverse clinical outcomes in heart failure. American Heart Journal, 178, pp. 108-114.


© Elsevier


  • AM (Accepted Manuscript)

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This work is made available according to the conditions of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) licence. Full details of this licence are available at: https://creativecommons.org/licenses/by-nc-nd/4.0/

Publication date



This paper was accepted for publication in the journal American Heart Journal and the definitive published version is available at https://doi.org/10.1016/j.ahj.2016.05.008






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