RESUMO
Background: Thyroid hormone has a differential action on healthy and ischemic heart. Triiodothyronine (T3) administration improved postischemic cardiac function while it limited apoptosis in experimentally induced ischemia. Thus, the present study investigated the potential effects of acute liothyronine (LT3) treatment in patients with anterior myocardial infarction. Methods: This study is a pilot, randomized, double-blind, placebo-controlled trial (ThyRepair study). We randomized 52 patients and analyzed data from 37 patients (n = 16 placebo and n = 21 LT3), per prespecified per protocol analysis. We excluded three patients who had died of cardiovascular causes (one in placebo and two in LT3 arm), four with small infarct size below a pre-specified threshold (in the placebo arm), and the rest, who lacked follow-up data. LT3 treatment started after stenting as an intravenous (i.v.) bolus injection of 0.8 µg/kg of LT3 followed by a constant infusion of 0.113 µg/kg/h i.v. for 48 hours. All patients had cardiac magnetic resonance (CMR) at hospital discharge and 6 months follow-up. The primary end point was CMR left ventricular (LV) ejection fraction (LVEF) and secondary endpoints were LV volumes, infarct volume (IV), and safety. Results: The CMR LVEF% at 6 months was 53.6 ± 9.5 for the LT3-treated group and 48.6 ± 11 for placebo, p = 0.15. Acute LT3 treatment resulted in a significantly lower LV end-diastolic volume index (92.2 ± 16.8 mL/m2 vs. 107.5 ± 22.2, p = 0.022) and LV systolic volume index (47.5 ± 13.9 mL/m2 vs. 61.3 ± 21.7, p = 0.024) at hospital discharge, but not at 6 months. There was no statistically significant difference in CMR IV at hospital discharge between the groups (p = 0.24). CMR IV tended to be lower in the LT3-treated group at 6 months (18.7 ± 9.5 vs. 25.9 ± 11.7, in placebo, p = 0.05). Serious, life-threatening events related to LT3 treatment were not observed. A tendency for an increased incidence of atrial fibrillation (AF) was found in the LT3 group during the first 48 hours (19% for T3 group vs. 5% for placebo, p = 0.13). Conclusion: This pilot randomized, placebo-controlled trial study suggests potential favorable effects (acute cardiac dilatation and 6-month IV) as well as potential concerns regarding a higher risk of AF after LT3 administration early after myocardial infarction, which should be tested in a larger scale study.
Assuntos
Infarto do Miocárdio , Tri-Iodotironina , Angioplastia , Método Duplo-Cego , Humanos , Infarto do Miocárdio/tratamento farmacológico , Projetos Piloto , Resultado do Tratamento , Tri-Iodotironina/uso terapêuticoRESUMO
AIMS: To compare the treatment and outcomes of myocardial infarction patients in hospitals with and without catheterization laboratory. METHODS AND RESULTS: The Hellenic Infarction Observation Study was a countrywide registry of acute myocardial infarction, conducted during 2005-2006. The registry enrolled 1840 patients with myocardial infarction from 31 hospitals with a proportional representation of all types of hospitals and of all geographical areas. Out of these patients, 645 (35%) were admitted in 11 hospitals with and 1195 (65%) in 20 hospitals without catheterization laboratory. Patients admitted in hospitals with catheterization laboratory in comparison with patients admitted in hospitals without were younger (66+/-14 vs. 68+/-13, P<0.004) with less diabetes (27 vs. 33%, P<0.001), but without other baseline differences (female 27 vs. 25%, prior myocardial infarction 20 vs. 17%, Killip class>1 22 vs. 23%). Reperfusion rates for ST-segment elevation myocardial infarction were 67% (43% lytic, 24% primary percutaneous coronary interventions) versus 56% (55% lytic, 1% percutaneous coronary interventions; P<0.01). In-hospital outcomes in hospitals with versus in hospitals without laboratory were: mortality 6.5 versus 8.3% (NS), stroke 2.2 versus 1.1% (NS), major bleeding 1.1 versus 0.6% (NS), and heart failure 11 versus 16% (P<0.01). In multivariate regression analysis, being admitted in a hospital without catheterization laboratory was not an independent predictor of increased in-hospital mortality (odds ratio=1.18, 95% confidence interval: 0.72-1.93, P=0.505). CONCLUSION: Although the majority of acute myocardial infarction patients was admitted in hospitals without catheterization laboratory, these patients do not have a survival disadvantage, provided they are treated with lytic therapy, medical secondary prevention drugs, and eventual revascularization according to current guidelines.
Assuntos
Cateterismo Cardíaco , Instalações de Saúde/estatística & dados numéricos , Hospitalização , Infarto do Miocárdio/terapia , Avaliação de Resultados em Cuidados de Saúde , Antagonistas Adrenérgicos beta/uso terapêutico , Idoso , Angina Pectoris/epidemiologia , Angioplastia Coronária com Balão , Bloqueadores do Receptor Tipo 1 de Angiotensina II/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Anticoagulantes/uso terapêutico , Uso de Medicamentos , Feminino , Grécia/epidemiologia , Insuficiência Cardíaca/epidemiologia , Heparina/uso terapêutico , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Masculino , Infarto do Miocárdio/epidemiologia , Reperfusão Miocárdica , Inibidores da Agregação Plaquetária/uso terapêutico , Recidiva , Sistema de Registros , Choque/epidemiologia , Acidente Vascular Cerebral/epidemiologiaRESUMO
Metastatic tumors in the pericardium or the heart are more common than primary tumors and their incidence has increased during the last decades due to the prolonged survival of patients with cancer and the increased prevalence of the disease in the general population. We present the case of a 36-year-old patient admitted to our hospital due to fatigue, dyspnea, and episodes of dizziness and fainting during the last month. He had a history of a malignant skin melanoma surgically removed 4 years ago. The echo study identified multiple metastases in the heart involving the pericardium, the myocardium and the right atrium, where the tumor was mobile creating mechanical tricuspid valve stenosis. Malignant metastasis was confirmed by pericardiocentesis and, although treatment with chemotherapy was promptly initiated, the patient died 4 months later. Despite the difficulty in clinical diagnosis of cardiac melanoma, early detection has important therapeutic and prognostic implications. Echocardiography is the most common diagnostic modality and transesophageal approach may be the technique of choice to image intracardiac metastatic tumors.
Assuntos
Neoplasias Cardíacas/diagnóstico por imagem , Melanoma/diagnóstico por imagem , Neoplasias Cutâneas/patologia , Adulto , Evolução Fatal , Neoplasias Cardíacas/secundário , Humanos , Masculino , Melanoma/secundário , UltrassonografiaRESUMO
BACKGROUND: Primary aldosteronism (PA) has been experimentally and clinically linked to myocardial and vascular fibrosis, and it has been further associated with left ventricular (LV) structural adaptations. HYPOTHESIS: Functional cardiovascular adaptations in hypertensive patients with PA precede structural alterations in the early stages of the disease. METHODS: We studied 17 hypertensive subjects with a recent diagnosis of PA (10 male patients, aged approximately 55 y, with office blood pressure [BP] of 137/88 mm Hg), and 30 essential hypertensives matched for age, sex, office BP levels, treatment status, and LV mass index (LVMI). Apart from standard 2-Dimensional (2-D) and conventional Doppler parameters, tissue Doppler imaging (TDI) methodology was used to assess LV diastolic function; averaging early and late diastolic mitral annular peak velocities (Emav/, Amav, Emav/Amav ratio) from 4 separate sites of measurement (septal, lateral, anterior, and inferior walls). Aortic stiffness was evaluated by means of carotid-femoral pulse wave velocity (cf-PWV) measurements. RESULTS: Although transmitral E/A ratio was similar in both groups (0.95+/-0.26 versus 0.98+/-0.24, p=0.66), hypertensive subjects with PA compared with essential hypertensives are characterized by significantly higher relative wall thickness (0.50+/-0.07 versus 0.41+/-0.06, pAssuntos
Aorta/fisiopatologia
, Ecocardiografia
, Coração/fisiopatologia
, Hiperaldosteronismo/fisiopatologia
, Hipertensão/fisiopatologia
, Função Ventricular Esquerda
, Elasticidade
, Feminino
, Humanos
, Hiperaldosteronismo/complicações
, Hiperaldosteronismo/diagnóstico por imagem
, Hipertensão/etiologia
, Masculino
, Pessoa de Meia-Idade
, Remodelação Ventricular
RESUMO
BACKGROUND: Previous studies have demonstrated that patients with heart failure have increased myocardial heat production. Coronary sinus (CS) thermography is a new method for the evaluation of left ventricular heat production. AIMS: We investigated whether the CS blood temperature is increased in patients with idiopathic dilated cardiomyopathy (DCM) compared to a control group and whether the CS blood temperature correlates with ejection fraction and systemic inflammatory activation. METHODS AND RESULTS: We included 25 patients with DCM and 22 healthy subjects. Temperature measurements were performed using a new thermography catheter. Temperature difference (DeltaT) was defined as the difference between the CS and RA blood temperature. The CRP levels were also measured. DeltaT was significantly greater in patients with DCM compared to the controls (0.25+/-0.09 vs 0.14+/-0.07 degrees C, p<0.01). DeltaT and EF were inversely correlated in patients with DCM (R=0.43). We categorized patients with DCM into two groups using a CRP cut-off value of < or =1 mg/dL. DeltaT in patients with high CRP was less (0.21+/-0.06 degrees C) compared to patients with low CRP (0.30+/-0.08 degrees C, p=0.01). CONCLUSIONS: In patients with DCM increased heat production from the myocardium, as estimated from the coronary sinus blood temperature, was demonstrated, interestingly there was no correlation with systemic inflammatory activation.
Assuntos
Temperatura Corporal , Cardiomiopatia Dilatada/fisiopatologia , Vasos Coronários/fisiopatologia , Ventrículos do Coração/fisiopatologia , Inflamação/fisiopatologia , Contração Miocárdica/fisiologia , Termografia , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Volume SistólicoRESUMO
OBJECTIVE: Left atrial (LA) enlargement is an index of adverse cardiovascular events. We sought to investigate any possible correlation between haemodynamic load, neurohumoral factors and LA size in the early stages of essential hypertension. METHODS: We studied 94 consecutive middle-aged subjects, with newly diagnosed stage I-II essential hypertension without left ventricular (LV) hypertrophy and 34 age and sex-matched normotensive individuals. Ambulatory blood pressure (BP) monitoring, plasma levels of brain natriuretic peptide (BNP), metabolic profile and left atrial volume index (LAVI), an echocardiographic measurement of LA volume indexed for the body surface area, constituted the work-up of all subjects. RESULTS: Hypertensive compared with normotensive subjects had significantly increased office and ambulatory systolic and diastolic BP (P < 0.0001 for all cases) as well as body mass index and waist-to-hip ratio (P < 0.05 for both cases). BNP levels were greater in hypertensive compared with normotensive subjects but were not statistically significant (20.4 versus 17.1 pg/ml, P = NS). Hypertensive compared with normotensive subjects also had significantly increased LV mass index (105 versus 84 g/m, P < 0.0001), LA diameter (39 versus 36 mm, P < 0.0001), and LAVI (22 versus 19 ml/m, P < 0.05). In the hypertensive population, LAVI exhibited significant positive relationships with office systolic BP, ambulatory pulse pressure, LV mass index and BNP. In multiple linear regression analysis only LV mass index and BNP were significantly associated with LAVI (beta = 0.298, P = 0.030 and beta = 0.322, P = 0.009, respectively). CONCLUSIONS: Increased LAVI, closely associated with LV mass index and BNP, was still found in the early stages of essential hypertension. However, the clinical significance of these findings remains to be elucidated in future studies.
Assuntos
Átrios do Coração/patologia , Hipertensão/sangue , Peptídeo Natriurético Encefálico/sangue , Adulto , Antropometria , Pressão Sanguínea/fisiologia , Monitorização Ambulatorial da Pressão Arterial , Ecocardiografia , Feminino , Átrios do Coração/diagnóstico por imagem , Humanos , Hipertensão/patologia , Hipertensão/fisiopatologia , Hipertrofia Ventricular Esquerda/diagnóstico , Hipertrofia Ventricular Esquerda/patologia , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Fatores de TempoRESUMO
In this study, we investigated possible relations between left ventricular (LV) concentric remodeling and plasma levels of high-sensitivity C-reactive protein (hs-CRP) and serum amyloid-A (SAA) in subjects who had essential hypertension; 65 consecutive subjects who had hypertension, did not have diabetes, and had normal LV mass were categorized as those whose LV relative wall thickness was <0.44 (n = 41) and those whose relative wall thickness was > or =0.44. Venous blood samples were collected for determination of metabolic profile and plasma levels of hs-CRP and SAA. Subjects whose relative LV wall thickness was > or =0.44 compared with those whose relative LV wall thickness was <0.44 had significantly increased systolic blood pressure by 4.5 mm Hg (p = 0.015) and higher levels of plasma hs-CRP (1.80 vs 1.39 mg/L, p = 0.001) and SAA (10.22 vs 4.86 mg/dl, p = 0.000), although the 2 groups did not differ with regard to age, gender, waist-to-hip ratio, and diastolic blood pressure (p = NS for all). In the entire study population, log hs-CRP and SAA exhibited positive relations with systolic blood pressure (r = 0.21 and r = 0.29, respectively; p <0.05 for the 2 markers) and relative wall thickness (r = 0.26 and r = 0.81, respectively; p <0.05 for the 2 markers). Multiple linear regression analysis showed that age, gender, and diastolic blood pressure were significantly associated with LV mass index (p <0.05), whereas gender, body mass index, log hs-CRP, and SAA were significantly associated with relative wall thickness (p <0.003). By analysis of covariance, log hs-CRP and SAA were significantly different between subjects whose relative LV wall thickness was > or =0.44 and those whose relative LV wall thickness was <0.44 after the adjustment for age, gender, body mass index, and systolic/diastolic blood pressure (p <0.005 for the 2 markers). In conclusion, alterations in LV geometry are associated with increased serum CRP and SAA levels in patients who are newly diagnosed with essential hypertension.
Assuntos
Proteína C-Reativa/análise , Hipertensão/diagnóstico , Proteína Amiloide A Sérica/análise , Remodelação Ventricular/fisiologia , Adulto , Anti-Hipertensivos/uso terapêutico , Biomarcadores/análise , Estudos de Coortes , Progressão da Doença , Feminino , Humanos , Hipertensão/sangue , Hipertensão/tratamento farmacológico , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Probabilidade , Prognóstico , Estudos Prospectivos , Medição de Risco , Sensibilidade e Especificidade , Índice de Gravidade de DoençaRESUMO
An increased prevalence of coronary artery ectasia (CAE) and a low frequency of diabetes mellitus have been reported in patients with abdominal aortic aneurysm (AAA). The prevalence of diabetes was studied in 190 patients with CAE in comparison with 341 age- and gender-matched patients with coronary artery disease alone. Diabetes mellitus was found to be independently but inversely associated with CAE (relative risk 0.603, 95% confidence interval 0.375 to 0.960, p = 0.037), thus resembling the relation between diabetes and AAA.
Assuntos
Doença da Artéria Coronariana/complicações , Vasos Coronários/patologia , Complicações do Diabetes , Angiopatias Diabéticas/complicações , Adulto , Idoso , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/epidemiologia , Diabetes Mellitus/diagnóstico por imagem , Diabetes Mellitus/epidemiologia , Angiopatias Diabéticas/diagnóstico por imagem , Angiopatias Diabéticas/epidemiologia , Dilatação Patológica/complicações , Dilatação Patológica/diagnóstico por imagem , Dilatação Patológica/epidemiologia , Feminino , Grécia/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prevalência , Estudos Retrospectivos , Fatores de Risco , Estatística como AssuntoRESUMO
OBJECTIVE: Familial hypercholesterolaemia (FH) is a frequent genetic disorder in Europe, affecting one in 500 people in its heterozygous form. Both homozygous and heterozygous forms are correlated with increased incidence of cardiovascular events. METHODS: We investigated clinical and biochemical parameters possibly associated with the results of exercise testing (ET) in asymptomatic patients with heterozygous FH. The study population was derived from outpatients of the Lipid Center in our department and consisted of 194 patients with heterozygous FH who had no medical history of coronary artery disease (CAD) or angina-like symptoms and who had agreed to undergo ET. RESULTS: Sex, body mass index, smoking status, diabetes mellitus, family history of CAD, presence of xanthomas and total cholesterol, triglyceride, low-density and high-density lipoprotein cholesterol, apolipoproteins A and B and lipoprotein (a) levels did not differ significantly between patients with positive and negative ET. Higher fibrinogen levels, arterial hypertension and family history of CAD were more frequent among patients with positive ET. However, in multivariate analysis adjusted for all the aforementioned variables, only high fibrinogen levels were significantly and independently associated with a positive result of ET. CONCLUSIONS: Lipid and coronary risk factor profiles do not seem to predict exercise-induced myocardial ischaemia in asymptomatic patients with heterozygous FH. However, in this high-risk population for cardiovascular events, fibrinogen levels are an independent predictor of positive ET. The adverse effects of FH on the cardiovascular system may be partly mediated by coagulability factors, whose role in the management of FH patients remains to be fully clarified.
Assuntos
Teste de Esforço , Hiperlipoproteinemia Tipo II/fisiopatologia , Adulto , Exercício Físico/fisiologia , Feminino , Fibrinogênio/análise , Humanos , Hiperlipoproteinemia Tipo II/sangue , Lipídeos/sangue , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Isquemia Miocárdica/sangue , Isquemia Miocárdica/fisiopatologia , Curva ROC , Fatores de Risco , Sensibilidade e EspecificidadeAssuntos
Doença Cardíaca Carcinoide/diagnóstico por imagem , Tumor Carcinoide/patologia , Ecocardiografia/métodos , Tumores Neuroendócrinos/complicações , Assistência ao Convalescente , Idoso , Ascite/tratamento farmacológico , Ascite/cirurgia , Doença Cardíaca Carcinoide/complicações , Doença Cardíaca Carcinoide/tratamento farmacológico , Doença Cardíaca Carcinoide/patologia , Tumor Carcinoide/complicações , Feminino , Humanos , Fígado/diagnóstico por imagem , Fígado/patologia , Tumores Neuroendócrinos/patologia , Tumores Neuroendócrinos/secundário , Paracentese/métodos , Somatostatina/análogos & derivados , Somatostatina/metabolismo , Resultado do TratamentoAssuntos
Agaricales , Infarto Miocárdico de Parede Anterior/etiologia , Trombose Coronária/complicações , Síndrome de Kounis/cirurgia , Intoxicação Alimentar por Cogumelos/complicações , Stents/efeitos adversos , Infarto Miocárdico de Parede Anterior/diagnóstico , Infarto Miocárdico de Parede Anterior/cirurgia , Angiografia Coronária , Trombose Coronária/diagnóstico , Humanos , Síndrome de Kounis/diagnóstico , Masculino , Pessoa de Meia-Idade , Falha de PróteseRESUMO
Dual left anterior descending artery (LAD) is a rare coronary artery anomaly. Dual but normally originated LAD has been usually reported to have no clinical significance. In this case report, we present a case of a middle age year old male with atypical anginal symptoms in whom coronary arteriography showed dual LAD with anomalous origin of one branch from the right coronary artery.
Assuntos
Anomalias dos Vasos Coronários/diagnóstico por imagem , Angiografia Coronária , Humanos , Masculino , Pessoa de Meia-IdadeAssuntos
Dextrocardia/terapia , Infarto do Miocárdio/terapia , Intervenção Coronária Percutânea/métodos , Artéria Radial , Doença Aguda , Idoso de 80 Anos ou mais , Angiografia , Angioplastia Coronária com Balão , Dextrocardia/complicações , Dextrocardia/diagnóstico por imagem , Dextrocardia/fisiopatologia , Eletrocardiografia , Humanos , Masculino , Infarto do Miocárdio/fisiopatologiaRESUMO
Coronary artery fistulas are rare anomalies of the coronary arteries that may sometimes be totally asymptomatic and can be found incidentally during coronary arteriography later in adult life. We report the case of a 75-year-old man with such a fistula and describe our diagnostic approach. In addition, we review the literature on the etiology, epidemiology, the diagnostic modalities and treatment of coronary fistulas.
Assuntos
Anomalias dos Vasos Coronários/diagnóstico , Fístula Vascular/diagnóstico , Idoso , Angiografia Coronária , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/terapia , Humanos , Achados Incidentais , Imageamento por Ressonância Magnética , Masculino , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/terapiaRESUMO
We present the case of a 42-year-old man with mitral valve prolapse (MVP) and infective endocarditis. He was referred to our hospital by his family physician for the evaluation of a cardiac murmur. A detailed medical history revealed that he had been feeling fatigue with occasional episodes of slight fever during the last two months. Echocardiography revealed MVP with a sizeable vegetation and severe mitral insufficiency. Serial blood cultures were positive for Streptococcus viridans, highly penicillin susceptible. He was put on appropriate antimicrobial therapy, but both the vegetation and the concomitant mitral insufficiency persisted after otherwise successful medical therapy. Thus, the patient underwent surgical vegetectomy with mitral valve repair. He had an uneventful postoperative course and remains free of disease at the 12-month follow up. Our case report reinforces the value of early diagnosis in the presence of a high clinical suspicion of MVP endocarditis. An extended clinical workup, including serial detailed echocardiography studies, is mandatory in such a patient. Medical treatment of infective endocarditis in the setting of MVP is often successful. However, cardiac surgical intervention plays an important role in the treatment of intracardiac complications. Mitral valve repair in the context of a healed and stable infective endocarditis is the treatment of choice.
Assuntos
Endocardite Bacteriana/cirurgia , Prolapso da Valva Mitral/cirurgia , Infecções Estreptocócicas/terapia , Estreptococos Viridans , Adulto , Endocardite Bacteriana/complicações , Endocardite Bacteriana/diagnóstico , Humanos , Masculino , Prolapso da Valva Mitral/diagnóstico , Prolapso da Valva Mitral/microbiologia , Infecções Estreptocócicas/diagnósticoRESUMO
A large intracardiac mass is a rare condition and one with an extremely high risk of haemodynamic and embolic complications. Urgent surgical excision is the treatment of choice, and the histological examination reveals the exact nature of the mass, usually a myxoma or a thrombus. We present the case of an 80-year-old woman, with a history of atrial fibrillation, who was admitted because of a seriously impaired level of consciousness, and fever. A large cerebral infarct and a urinary tract infarction were diagnosed. On the transthoracic echocardiogram a giant, free-floating mass was detected in the left atrium, transiently obstructing the mitral valve orifice. Based on the features of the mass and patient's history, it was considered more likely to be a thrombus rather than a tumour. Given the patient's extremely unfavourable neurological status, cardiac surgery was considered to be contraindicated and the patient was administered unfractionated heparin intravenously. Unfortunately, after a few hours the patient suffered a cardiac arrest and died.
Assuntos
Fibrilação Atrial/complicações , Cardiopatias/complicações , Trombose/complicações , Idoso de 80 Anos ou mais , Evolução Fatal , Feminino , Átrios do Coração , Cardiopatias/patologia , Humanos , Trombose/patologiaRESUMO
INTRODUCTION: Congestive heart failure (HF) is characterised by increased proinflammatory stimulation and impaired endothelial function. Statin treatment exerts a beneficial effect on endothelial function and inflammatory process in patients with atherosclerosis. However, its effect in patients with HF is not well studied. Therefore, in the present study we compared the effect of short-term treatment with rosuvastatin or ezetimibe on endothelial function in patients with HF. METHODS: In this double-blind, placebo controlled, cross-over trial, 22 patients with HF were randomised to receive ezetimibe 20 mg/d or rosuvastatin 10 mg/d for 4 weeks, with 4 weeks wash-out period between the two interventions. Endothelial function was evaluated by flow mediated dilation (FMD) in the brachial artery at the beginning and at the end of each treatment period. RESULTS: There was no change in the baseline brachial diameter after treatment with either ezetimibe (p=NS) or rosuvastatin (p=NS). However, there was a significant improvement of FMD in the rosuvastatin group (p<0.05) but not in the ezetimibe group (p=NS). The changes in lipid levels were similar between groups (p=NS). The change in FMD was not significantly correlated with the decrease of serum LDL in either the ezetimibe or rosuvastatin treated groups. CONCLUSIONS: Rosuvastatin improves endothelial function in patients with congestive heart failure, by mechanisms independent of lipid-lowering. On the contrary, lipid-lowering treatment achieved by ezetimibe is unable to affect endothelial function in these patients. These findings indicate a direct beneficial effect of statins in patients with congestive heart failure, further to lipid-lowering.