Vascular and Microvascular Endothelial Function in Heart Failure With Preserved Ejection Fraction

Area of Science:

• Cardiology
• Vascular Biology
• Physiology

Background:

• Assessing vascular endothelial function in heart failure with preserved ejection fraction (HFpEF) remains inconsistent.
• Microvascular endothelial function in HFpEF has been incompletely evaluated.

Purpose of the Study:

• To comprehensively assess macrovascular and microvascular endothelial function in patients with HFpEF.
• To compare endothelial function between HFpEF patients and matched hypertensive controls without heart failure.

Main Methods:

• 90 patients were studied: 45 with HFpEF and 45 matched hypertensive controls.
• Vascular function was assessed using Doppler echocardiography, arterial wave reflections, arterial stiffness, brachial artery flow-mediated dilation (FMD), and forearm cutaneous blood flow.
• Measurements included resting and post-occlusion blood flow, and arterial pressures.

Main Results:

• HFpEF patients exhibited significantly lower brachial artery FMD compared to controls (P = .001).
• Forearm microvascular function, assessed by post-occlusion peak blood flow, was reduced in HFpEF patients (P = .03).
• HFpEF patients had increased pulse pressure and pressure augmentation despite similar mean blood pressures.

Conclusions:

• Patients with HFpEF demonstrate depressed endothelial function in both forearm vasculature and microvasculature.
• These findings highlight widespread vascular dysfunction in HFpEF beyond macrovascular measures.