Endothelial dysfunction and heart failure: A review of the existing bibliography with emphasis on flow mediated dilation

Abstract

Heart failure affects 1-2% of the population worldwide, and it is characterized by episodes of decompensation often requiring hospitalization. Although targeted treatment has reduced the prevalence of rehospitalizations to 30-50%, mortality rates remain high. A complex blend of structural and functional alterations accounts for the genesis and progression of heart failure, but the exact underlying pathophysiology remains poorly understood. The aim of this review is to summarize endothelial dysfunction and its role in the pathogenesis and progression of heart failure. Moreover, it sums up all the appropriate methods of assessing endothelial dysfunction emphasizing on flow-mediated dilation and introduces endothelium as a potential target for new therapeutic development and research in the wide spectrum of the syndrome called heart failure.

Keywords: Heart failure; cardiology; endothelial dysfunction.

Figure 1.

Endothelial dysfunction in the pathophysiology of HF. Endothelial dysfunction through vascular, renal and neurohormonal mechanisms leads to fluid overload. It also causes vasoconstriction of the capacitance veins leading to centralisation of blood volume. Moreover, congestion itself, through the same mechanisms, leads to more fluid retention and consequently to the vicious cycle of heart failure. An insult combined with the progressive fluid overload may lead to decompensated HF.

Figure 2.

Methods of assessing endothelial dysfunction.