Endothelial function and arterial stiffness in post-ischemic vs. idiopathic dilated cardiomyopathy: propensity score matched analysis
K Mourouzis, V Tsigkou, E Oikonomou, E Bletsa, M Zaromitidou, G Siasos, K Tsioufis, D TousoulisAbstract
Background
Endothelial dysfunction and arterial stiffness contribute to heart failure pathophysiology. In ischemic dilated cardiomyopathy, it remains unclear whether these changes result from heart failure itself or advanced atherosclerosis, and conflicting data exist regarding differences in endothelial dysfunction and arterial stiffness between patients with dilated cardiomyopathy of ischemic etiology (ICM) and idiopathic etiology (IDCM).
Purpose
This study investigated endothelial dysfunction and arterial stiffness in patients with ICM and IDCM.
Methods
263 patients with ICM and 51 with IDCM (87.1% vs. 70.6% male; p=0.01) with LVEF ≤49% and LVEDD >58 mm (males) or >52 mm (females) were included. Endothelial dysfunction was assessed noninvasively with brachial artery flow-mediated dilatation (FMD), and arterial stiffness was measured using carotid-femoral pulse wave velocity (cf-PWV) and augmentation index (AIx). After crude analysis comparisons, propensity score matching was performed using the MatchIt package in R (1:2 nearest neighbor matching without replacement using Mahalanobis distance on age, sex, and LVEF) to balance baseline characteristics between IDCM (n=41) and ICM (n=82) patients.
Results
ICM patients were older (68±12 vs. 61±15 years; p=0.001), had lower BMI (27.45±4.57 vs. 33.95±18.54 kg/m²; p=0.001), lower LDL-C (95±38 vs. 120±31 mg/dL; p=0.01), similar LVEF [30(25-35)% vs. 30(25-40)%; p=0.22], and less ventricular dilation (LVEDD 56±7 vs. 59±7 mm; p=0.01) than IDCM patients. No differences were observed in white blood cell count or serum creatinine (p=NS). ICM patients had higher smoking history (81.3% vs. 64.7%; p=0.04) and hypertension prevalence (60.3% vs. 52.9%; p=0.04). IDCM patients demonstrated better FMD (6.31±2.94% vs. 5.10±2.86%; p=0.001) and lower AIx (20±9 vs. 25±14; p=0.04), with no cf-PWV differences (8.75±2.76 vs. 10.35±7.92 m/s; p=0.21). After matching, no differences remained in age, sex, or cardiovascular risk factors, with similar LVEF between groups. ICM patients maintained worse FMD (5.01±2.64% vs. 6.31±2.94%; p=0.001) and higher AIx (24±11 vs. 20±9; p=0.04), with no cf-PWV differences (p=NS).
Conclusion
Dilated cardiomyopathy of ischemic etiology demonstrates impaired endothelial function and increased arterial stiffness independent of age, sex compared to IDCM, suggesting intrinsic vascular pathology beyond ischemic etiology .