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Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
Published on: February 13, 2021
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Reduced Lymphatic Reserve in Heart Failure With Preserved Ejection Fraction
Giacomo Rossitto1, Sheon Mary2, Christine McAllister3
1Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom; Department of Medicine, Università degli Studi di Padova, Padova, Italy.
Journal of the American College of Cardiology
|December 11, 2020
Summary
Heart failure with preserved ejection fraction (HFpEF) involves microvascular dysfunction. This study found impaired lymphatic drainage in HFpEF patients, suggesting reduced lymphatic reserve as a potential therapeutic target.
Area of Science:
- Cardiovascular Medicine
- Physiology
- Pathology
Background:
- Microvascular dysfunction is implicated in heart failure with preserved ejection fraction (HFpEF).
- The link between systemic microvasculature and HFpEF-related congestion remains unclear.
- This study investigates capillary-interstitium fluid exchange and lymphatic function in HFpEF.
Purpose of the Study:
- To examine capillary-interstitium fluid exchange in HFpEF.
- To assess lymphatic drainage capacity in HFpEF.
- To explore the role of tissue sodium excess in HFpEF pathophysiology.
Main Methods:
- Compared 16 HFpEF patients with 16 healthy controls.
- Utilized skin biopsies for vascular and chemical analyses.
- Employed venous occlusion plethysmography to measure microvascular filtration and lymphatic drainage.
Main Results:
- HFpEF patients exhibited rarefaction of blood and lymphatic vessels.
- Skin lymphatics in HFpEF showed reduced expression of lymphatic markers (LYVE-1, PROX-1).
- Lymphatic drainage was impaired in HFpEF, indicated by lower isovolumetric pressure.
Conclusions:
- Peripheral lymphatic vessels in HFpEF display structural and molecular abnormalities.
- Impaired lymphatic drainage contributes to fluid extravasation and interstitial accumulation in HFpEF.
- Reduced lymphatic reserve presents a novel therapeutic target for HFpEF management.
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