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. 2016 Feb 15;102(4):278-84.
doi: 10.1136/heartjnl-2015-308403. Epub 2015 Nov 13.

Evidence of microvascular dysfunction in heart failure with preserved ejection fraction

Joshua F Lee  1 , Zachary Barrett-O'Keefe  2 , Ryan S Garten  1 , Ashley D Nelson  3 , John J Ryan  4 , Jose N Nativi  4 , Russell S Richardson  5 , D Walter Wray  5
Affiliations

Evidence of microvascular dysfunction in heart failure with preserved ejection fraction

Joshua F Lee et al. Heart. .

Abstract

Objective: While vascular dysfunction is well defined in patients with heart failure (HF) with reduced ejection fraction (HFrEF), disease-related alterations in the peripheral vasculature of patients with HF with preserved ejection fraction (HFpEF) are not well characterised. Thus, we sought to test the hypothesis that patients with HFpEF would demonstrate reduced vascular function, at the conduit artery and microvascular levels, compared with controls.

Methods: We examined conduit artery function via brachial artery flow-mediated dilation (FMD) and microvascular function via reactive hyperaemia (RH) following 5 min of ischaemia in 24 patients with Class II-IV HFpEF and 24 healthy controls matched for age, sex and brachial artery diameter.

Results: FMD was reduced in patients with HFpEF compared with controls (HFpEF: 3.1±0.7%;

Controls: 5.1±0.5%, p=0.03). However, shear rate at time of peak brachial artery dilation was lower in patients with HFpEF compared with controls (HFpEF: 42 070±4018/s;

Controls: 69 018±9509/s, p=0.01), and when brachial artery FMD was normalised for the shear stimulus, cumulative area-under-the-curve (AUC) at peak dilation, the between-group differences were eliminated (HFpEF: 0.11±0.03%/AUC;

Controls: 0.09±0.01%/AUC, p=0.58). RH, assessed as AUC, was lower in patients with HFpEF (HFpEF: 454±35 mL;

Controls: 660±63 mL, p<0.01).

Conclusions: Collectively, these data suggest that maladaptations at the microvascular level contribute to the pathophysiology of HFpEF, while conduit artery vascular function is not diminished beyond that which occurs with healthy aging.

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Figures

FIGURE 1
FIGURE 1
Brachial artery flow-mediated dilation (FMD), expressed as percent (panel A) and absolute (panel B) change from baseline in heart failure patients with preserved ejection fraction (HFpEF) and healthy individuals (Controls). Data are presented as mean ± SE. * Significantly different from Controls, P ≤ 0.03.
FIGURE 2
FIGURE 2
Brachial artery flow-mediated dilation (FMD) normalized for shear rate area-under-the-curve (SR AUC), expressed as percent (panel A) and absolute (panel B) change from baseline in heart failure patients with preserved ejection fraction (HFpEF) and healthy individuals (Controls). Data are presented as mean ± SE.
FIGURE 3
FIGURE 3
Post-occlusion reactive hyperemia, expressed as both absolute blood flow (panel A) and as blood flow area-under-the-curve (AUC; panel B) in heart failure patients with preserved ejection fraction (HFpEF) and healthy individuals (Controls). Data are presented as mean ± SE. * Significantly different from Controls, P ≤ 0.02.
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