Microvascular dysfunction across organs in heart failure with preserved ejection fraction: the PROSE-HFpEF...

Area of Science:

• Cardiology
• Vascular Biology
• Nephrology

Background:

• Systemic microvascular dysfunction (MVD) is a proposed key factor in heart failure with preserved ejection fraction (HFpEF).
• This study investigated and compared MVD across various vascular beds in HFpEF patients and controls.

Purpose of the Study:

• To compare microvascular function in HFpEF patients versus controls across retinal, skin, and renal vascular beds.
• To explore potential sex and diabetes mellitus interactions in microvascular dysfunction within HFpEF.

Main Methods:

• A prospective, case-control study involving 138 HFpEF patients (≥60 years) and 2140 controls.
• Microvascular assessments included retinal vessel calibers (CRVE/CRAE), retinal dilation, skin microvascular flowmotion, skin hyperemia, and urinary albumin-to-creatinine ratio (UACR).
• Analyses were adjusted for confounders (age, sex, BMI, diabetes, etc.) and tested for interactions with sex and diabetes.

Main Results:

• Confounder-adjusted analyses revealed significant differences in retinal vessel calibers (CRVE, CRAE trend) and higher UACR in HFpEF patients.
• Skin microvascular function (flowmotion, hyperemia) did not differ significantly between groups after adjustments.
• Sex-specific differences were noted: narrower CRVE in female HFpEF patients, and more pronounced higher UACR in male HFpEF patients. Lower skin endothelial flowmotion was observed in patients with co-occurring diabetes.

Conclusions:

• HFpEF patients exhibit microvascular differences across multiple vascular beds compared to controls.
• Adjusted analyses confirm persistent differences in retinal and renal microvasculature, supporting a systemic MVD in HFpEF.
• Findings suggest a systemic MVD process in HFpEF, potentially with sex-specific pathophysiological mechanisms.