Evaluation of arteriolar hyalinosis of the skin of patients with chronic congestive heart failure

Arteriosclerotic changes in the myocardium, lung, and kidney in dogs with chronic congestive heart failure and myxomatous mitral valve disease

BACKGROUND

The occurrence of small vessel arteriosclerosis in the myocardium, kidney, and lung in dogs with naturally occurring myxomatous mitral valve disease has not been previously investigated systematically.

METHODS

Twenty-one dogs with naturally occurring congestive heart failure and 21 age-matched, sex-matched, and weight-matched control dogs underwent extensive pathological and histopathological examination. Morphometry and scoring of tissue sections were used to measure arterial narrowing and fibrosis in the myocardium, kidney, and lung; and intimal thickness and plaque formation in the aorta and pulmonary artery.

RESULTS

Dogs with congestive heart failure had significantly more arterial narrowing in the left ventricle (P < .003), lung (P < .0001), and kidney (P < .02); intimal-medial thickening in the pulmonary artery (P = .04); and fibrosis in the left ventricle (P < .0001) than control dogs. However, they did not have more plaque formation or intimal-medial thickening in the aorta than controls. There was significantly more arterial narrowing in papillary muscles than in all other locations in dogs with congestive heart failure (P < .002). In control dogs, arterial changes were less pronounced and did not differ in different locations.

CONCLUSIONS

Dogs with naturally occurring myxomatous mitral valve disease have significantly more arterial changes in the myocardium, lung, and kidney, and significantly more fibrosis in the myocardium than control dogs. This could have important implications in the management of myxomatous mitral valve disease and raises interesting questions about the occurrence and importance of intramural small vessel disease in humans with primary mitral valve prolapse.

Chronic heart failure is associated with vascular remodeling of the brachial artery

AIMS

Endothelial dysfunction has been shown to correlate with severity of congestive heart failure (CHF) and recent data suggest morphological changes of peripheral vasculature to be associated with the syndrome. We therefore investigated the hypothesis that vascular remodeling is associated with functional changes in peripheral conduit arteries and with systemic overexpression of ET-1 in patients suffering from CHF.

METHODS AND RESULTS

57 consecutive patients referred to the Innsbruck Heart Failure and Transplantation Program (EF=23+/-7%) and 16 matched controls (EF=60+/-5%) were studied. Flow-mediated vasodilation (FMD), nitroglycerin-mediated vasodilation (NMD), wall thickness (WT), and incremental elastic modulus (Einc) were assessed by high-resolution ultrasound of the brachial artery. FMD (P=0.004) and NMD (P=0.02) were significantly higher in controls as compared to moderate and severe CHF patients. In contrast, brachial artery-wall thickness (BA-WT) was increased in severe CHF patients (P=0.038). BA-WT was significantly correlated with both FMD (r=-0.28; P=0.049) and NMD (r=-0.38; P=0.003), and with the Einc (r=0.45, P=0.001). Lumen diameter was not different among groups. In patients with BA-WT>0.31 mm, bigET-1 was higher compared to BA-WT<0.31 mm (P<0.05).

CONCLUSION

CHF is associated with remodeling of the brachial artery, which is characterized by morphological, mechanical and functional changes of the vessel wall. Endothelin-1 may play a role in the vascular remodeling process.

Cutaneous arteriolar thioredoxin expression in patients with heart failure

Cutaneous microangiopathic lesions exist in patients with heart failure, and heart failure is associated with increased oxidative stress. Thioredoxin (TRX) is stress-inducible and has a cytoprotective effect against oxidative stress. Accordingly, to investigate whether arteriolar TRX expression was increased in the skin of patients with congestive heart failure (CHF), skin biopsies were taken at the time of cardiac catheterization, and the results were compared with those of control subjects. The diagnosis of CHF was done by cardiac catheterization with reference to elevated plasma concentrations of TRX and brain natriuretic peptide (BNP). Increased TRX expression was found in the skin biopsies of 29 of the 35 patients with CHF, but in none of the 8 control subjects; the semiquantitative grade of arteriolar TRX immunoreactivity was 2.5+/-1.0 in patients with CHF and 1.0+/-0.0 in controls, respectively (p<0.01). The severity of arteriolar TRX expression did not correlate with the New York Heart Association functional class. These results indicate that cutaneous arteriolar TRX expression in patients with CHF may reflect the excessive oxidative stress of the peripheral circulation associated with the condition.