Heart Failure Vascular Function and the Role of Oxidative Stress in Heart Failure, Heart Transplant, and Beyond

Abstract—Using flow-mediated vasodilation (FMD), reactive hyperemia, and an acute oral antioxidant cocktail (AOC; vitamins C and E and -lipoic acid), this study aimed to provide greater insight into altered vascular function and the role of oxidative stress in chronic heart failure patients with reduced ejection fraction (HFrEF) and at several time points beyond heart transplantation (HTx). A total of 61 age-matched subjects (12 healthy controls, 14 New York Heart Association class II and III HFrEF, and 35 HTx recipients [3 years post-HTx, 5–10 years post-HTx, and 14 years post-HTx]) ingested either placebo (PL) or an AOC before FMD and reactive hyperemia testing of the brachial artery. Vascular function, as measured by FMD, was not different among the controls (6.81.9%), recent 3-year post-HTx group (8.11.2%), and the 5- to 10-year post-HTx group (5.51.0%). However, PL FMD was lower in the HFrEF (4.50.7%) and in the 14-year post-HTx group (2.90.8%). The AOC increased plasma ascorbate levels in all of the groups but only increased FMD in the controls (PL, 6.81.9%; AOC, 9.21.0%) and 14-year post-HTx recipients (PL, 2.90.8%; AOC, 4.51.3%). There were no differences in reactive hyperemia in any of the groups with PL or AOC. This cross-sectional study reveals that, compared with controls, vascular function is blunted in HFrEF, is similar soon after HTx, but is decreased with greater time post-HTx with free radicals implicated in this progression. (Hypertension. 2012;60:659-668.) Key Words: antioxidants flow-mediated vasodilation vascular health blood flo