To investigate the dependence of structure of a.femoralis (a.F) and peripheral blood flow (PBF) on severity and 12-months survival prognosis of chronic heart failure (CHF).Design and Method:
Ultrasonography of a.F, a.dorsalis pedis (a.DP) were performed in 129 patients (age 56.6 ± 1.2 years; 89 males) with stable CHF (NYHA II-III) and LVEF < 40% and in 40 age-matched healthy subjects. Diameter (D), intima-media thickness (IMT) of a.F, velocities (Vps and Ved) in a.DP were measured; index of relative wall thickness (RWT) of a.F: RWT = IMT/D; index of peripheral resistance (RI): RI = (Vps-Ved)/Vps. Kaplan-Meier 12-months survival analysis was performed for RWT as well as for Vps, Ved, RI in a.DP based on «below median vs. above median» approach.Results:
In pts with CHF IMT and RWT were significantly higher (IMT: 0.99 ± 0.16 vs 0.59 ± 0.09 mm, p < 0.001; RWT: 0.16 ± 0.03 vs 0.10 ± 0.01unit, p < 0.001). Vps and Ved in a.DP were significantly lower in pts with CHF (39.3 ± 2.1 vs 56.4 ± 6.6 cm/s, p < 0.01 and 5.2 ± 0.8 vs 12.9 ± 1.7 cm/s, p < 0.01, respectively), and RI in a.DP was significantly higher (0.83 ± 0.04 vs 0.77 ± 0.02unit, p < 0.01). These changes become more pronounced in pts with NYHA class III-IV than in NYHA class II (Vps 32.3 ± 1.9 vs 35.7 ± 2.1 cm/s, p = 0.03, Ved 5.8 ± 0.7 vs 6.9 ± 1.3 cm/s, p = 0.03 and RI 0.84 ± 0.03 vs 0.82 ± 0.02unit, p = 0.04, respectively). Kaplan-Meier 12-months survival analysis was performed in relation to the RWT (p = 0.038), Vps in a.DP (p = 0.04), Ved in a.DP (p = 0.037) and RI in a.DP (p = 0.04). Significantly lower survival was apparent in pts with RWT > 0.16, Vps < 36cm/s, Ved < 6cm/s, RI > 0.84unit.Conclusions:
The present study indicates that remodeling of peripheral blood vessels is accompanied by decrease peripheral arterial blood flow and by increase in resistance of resistive vessels in patients with CHF. RWT, Vps, Ved and RI in a.DP may be used for mortality risk stratification in patients with CHF.