CAROTID ARTERIAL COMPLIANCE IN PATIENTS WITH CONGESTIVE-HEART-FAILURE SECONDARY TO IDIOPATHIC DILATED CARDIOMYOPATHY

Conduit artery distensibility affects the pulsatile component of afterload and may contribute to impaired left ventricular function in patients with congestive heart failure (CHF). The objectives of this study were to (1) determine whether arterial distensibility is reduced in patients with CHF, and (2) determine whether decreased arterial compliance is related to an abnormality in vascular wall structure (i.e., wall thickness or excessive levels of circulating neurohumoral vasoconstrictors, or both). The study participants included 40 patients with CHF secondary to idiopathic dilated cardiomyopathy and 33 age-matched healthy volunteers. High-resolution ultrasonography was performed to directly visualize the common carotid artery and measure its diameter and wall thickness. Its elastic properties were determined by relating changes in arterial diameter to changes in pressure generated with each heart beat. Carotid artery distensibility was less (14.1 +/- 1.1 vs 25.3 +/- 2.0 10(-6) . N-1 . m(2), p <0.001) and Young's modulus of elasticity was greater (3.99 +/- 0.51 vs 2.29 +/- 0.23 10(5) . N . m(-2), p <0.005) in patients with CHF than in normal subjects. Also, carotid artery wall thickness was increased in patients with CHF. When the entire population was considered, age, wall thickness, and plasma norepinephrine and aldosterone concentrations correlated inversely with distensibility, whereas age and plasma norepinephrine concentration correlated directly with elasticity. Among normal subjects, only age correlated inversely with distensibility, among patients with CHF, only plasma norepinephrine concentration correlated with elasticity. It is concluded that carotid artery distensibility is reduced in patients with CHF. Sympathetic nervous system activity may contribute actively to decreased arterial compliance in patients with CHF by increasing vascular tone in medium-sized arteries.