Vascular (dys)function in the failing heart.

Area of Science:

• Cardiovascular Medicine
• Vascular Biology
• Heart Failure Pathophysiology

Background:

• Heart failure (HF) encompasses more than cardiomyocyte dysfunction; vascular abnormalities are critical.
• Systemic and coronary vascular dysfunction initiate and perpetuate HF, impacting cardiac function and metabolism.
• HF exacerbates vascular dysfunction, creating a detrimental cycle affecting coronary blood flow and cardiac afterload.

Purpose of the Study:

• To provide a mechanistic framework of vascular dysfunction in HF pathogenesis.
• To explore the role of vascular alterations in HF with and without reduced ejection fraction.
• To highlight integrated therapeutic approaches targeting vascular dysfunction in HF.

Main Methods:

• Review of current literature on vascular function in HF.
• Analysis of mechanisms linking vascular changes to HF progression.
• Examination of therapeutic interventions targeting vascular aspects of HF.

Main Results:

• Systemic arterial dysfunction increases cardiac afterload, impairing contractile function.
• Reduced coronary blood flow compromises myocardial oxygen delivery and cardiomyocyte metabolism.
• Coronary microvascular dysfunction presents heterogeneous pathogenesis, complicating HF management.

Conclusions:

• Vascular dysfunction is a key driver and consequence of HF across ejection fraction spectrums.
• Understanding vascular alterations provides mechanistic insights for HF.
• Integrated therapies addressing vascular health are crucial for improving HF outcomes.