Endothelial Dysfunction in Heart Failure With Preserved Ejection Fraction: What are the Experimental Proofs?

Area of Science:

• Cardiovascular Medicine
• Pathophysiology
• Medical Research

Background:

• Heart failure with preserved ejection fraction (HFpEF) presents a significant challenge in cardiovascular medicine due to high morbidity and mortality.
• The prevalence of HFpEF is rising with an aging population and increasing comorbidities.
• Current understanding of HFpEF pathophysiology remains incomplete, lacking defined therapeutic targets.

Purpose of the Study:

• To review evidence supporting the causal role of endothelial dysfunction in the pathophysiology of HFpEF.
• To explore the proposed link between cardiovascular risk factors, systemic inflammation, and cardiac microvascular dysfunction in HFpEF.
• To discuss the implications of impaired coronary microvascular function in HFpEF patients.

Main Methods:

• Review of existing literature on HFpEF pathophysiology.
• Analysis of human and experimental models investigating endothelial cells (EC) and coronary microvascular dysfunction.
• Examination of studies correlating microvascular dysfunction with HFpEF severity.

Main Results:

• HFpEF patients exhibit decreased cardiac microvascular density and systemic endothelial dysfunction.
• A lower mean coronary flow reserve is observed in HFpEF patients.
• Impaired coronary microvascular function is associated with the severity of heart failure.

Conclusions:

• Endothelial dysfunction is a critical component in the pathophysiology of HFpEF.
• Cardiac small vessel disease, triggered by systemic inflammation from risk factors, may cause cardiac wall stiffening and diastolic dysfunction.
• Further research into endothelial dysfunction could reveal novel therapeutic targets for HFpEF.