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Meta-Analysis
. 2021 Aug;51(8):e13552.
doi: 10.1111/eci.13552. Epub 2021 May 22.

Clinical assessment of endothelial function in heart failure with preserved ejection fraction: A meta-analysis with meta-regressions

Pasquale Ambrosino  1 , Antimo Papa  1 , Agostino Buonauro  2 , Marco Mosella  1 , Ilenia Calcaterra  3 , Giorgio Alfredo Spedicato  4 , Mauro Maniscalco  1 , Matteo Nicola Dario Di Minno  5
Affiliations
Meta-Analysis

Clinical assessment of endothelial function in heart failure with preserved ejection fraction: A meta-analysis with meta-regressions

Pasquale Ambrosino et al. Eur J Clin Invest. 2021 Aug.

Abstract

Background: Endothelial dysfunction is a key mechanism in the development of cardiac remodelling and diastolic dysfunction in heart failure with preserved ejection fraction (HFpEF). Flow-mediated (FMD) and nitrate-mediated dilation (NMD) are noninvasive methods to assess endothelial function. We performed a meta-analysis evaluating the impact of HFpEF on FMD and NMD.

Methods: PubMed, Web of Science, Scopus and EMBASE databases were systematically searched according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Differences were expressed as mean difference (MD) with 95% confidence intervals (95%CI). The random effects method was used.

Results: A total of seven studies were included in the final analysis, 7 with data on FMD (326 HFpEF patients and 417 controls) and 3 on NMD (185 HFpEF patients and 271 controls). Compared to controls, HFpEF patients showed significantly lower FMD (MD: -1.929; 95%CI: -2.770, -1.088; P < .0001) and NMD values (MD: -2.795; 95%CI: -3.876, -1.715; P < .0001). Sensitivity analyses substantially confirmed results. Meta-regression models showed that increasing differences in E/A ratio (Z-score: -2.002; P = .045), E/E' ratio (Z-score: -2.181; P = .029) and left atrial diameter (Z-score: -1.951; P = .050) were linked to higher differences in FMD values between cases and controls.

Conclusions: Impaired endothelial function can be documented in HFpEF, with the possibility of a direct association between the severity of diastolic and endothelial dysfunction. Targeting endothelial dysfunction through pharmacological and rehabilitation strategies may represent an attractive therapeutic option.

Keywords: biomarkers; disability; exercise; heart failure; nitric oxide; rehabilitation.

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References

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