Endothelial dysfunction measured by peripheral arterial tonometry predicts prognosis in patients with heart failure with preserved ejection fraction

Matsue, Yuya; Suzuki, Makoto; Nagahori, Wataru; Ohno, Masakazu; Matsumura, Akihiko; Hashimoto, Yuji; Yoshida, Kazuki; Yoshida, Masayuki

doi:10.1016/j.ijcard.2012.09.021

Cited by 56 publications

(43 citation statements)

References 25 publications

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“…Differences in techniques importantly include the vascular bed examined; namely the conduit artery in brachial FMD and microvasculature in PAT. Applying PAT in patients with HFpEF, a higher prevalence of microvascular endothelial dysfunction was found compared to hypertensive- and age-matched controls,5 which independently predicted cardiovascular events 6 7. With FMD, patients with HFpEF had more peripheral endothelial dysfunction compared to hypertensive controls, which correlated with pulmonary vascular resistance explaining co-existing pulmonary hypertension8—although the severity of brachial artery endothelial dysfunction did not appear to be worse than in elderly controls 9…”

Section: Mounting Evidencementioning

confidence: 99%

Microvascular endothelial dysfunction in heart failure with preserved ejection fraction

Lam

Lund

2016

Heart

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Section: Mounting Evidencementioning

confidence: 99%

Microvascular endothelial dysfunction in heart failure with preserved ejection fraction

Lam

Lund

2016

Heart

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“…This haemodynamic assessment has been used in a number of patient groups, and has been identified as an independent predictor of prognosis in patients with HFrEF 23 and HFpEF, 14 suggesting that RH responses may provide important information for risk stratification and determination of disease progression. In the present study, we determined RH by quantifying the blood flow AUC following a 5 min cuff occlusion of the lower arm, and identified a profound (≈30%) reduction in RH in patients with HFpEF relative to healthy controls ( figure 3).…”

Section: Microvascular Function In Hfpefmentioning

confidence: 99%

Evidence of microvascular dysfunction in heart failure with preserved ejection fraction

Lee

Barrett-O’Keefe

Garten

et al. 2015

Heart

104

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Objective While vascular dysfunction is well-defined in HF patients with reduced ejection fraction (HFrEF), disease-related alterations in the peripheral vasculature of HF patients with preserved ejection fraction (HFpEF) are not well characterized. Thus, we sought test the hypothesis that HFpEF patients would demonstrate reduced vascular function, at both the conduit artery and microvascular levels, compared to controls. Methods We examined both conduit artery function via brachial artery flow-mediated dilation (FMD) and microvascular function via reactive hyperemia (RH) following 5 min of ischemia in 24 Class II–IV HFpEF patients and 24 healthy controls matched for age, sex, and brachial artery diameter. Results FMD was reduced in HFpEF patients compared to 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 HFpEF patients compared to controls (HFpEF: 42,070 ± 4,018 s−1; Controls: 69,018 ± 9,509 s−1; P = 0.01), and when brachial artery FMD was normalized 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 HFpEF patients (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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“…Prognostic data regarding the EndoPAT technique are rare. To the best of our knowledge, only two studies have investigated the prognostic value of this parameter in a cohort of patients with unexplained chest pain 14) and in patients with heart failure with a preserved ejection fraction 15) . Therefore, the purpose of the present study was to examine whether the PATratio can be used to predict future cardiovascular events in patients with angiographically proven coronary artery disease (CAD) or non-significant CAD with a high cardiovascular risk profile.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Value of Peripheral Arterial Tonometry in Patients with Coronary Artery Disease and a High Cardiovascular Risk Profile

Suessenbacher

Dörler

Wanitschek

et al. 2014

JAT

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Aim: Data regarding the prognostic value of peripheral endothelial function testing in patients with cardiovascular disease are conflicting. Peripheral arterial tonometry (PAT) is increasingly used to measure the peripheral endothelial function. The prognostic value of this method has not been investigated thus far in patients with cardiovascular disease and/or a high cardiovascular risk profile. Methods: In 96 patients with significant coronary artery disease (CAD) or ＜70% stenosis and ≥ three cardiovascular risk factors, reactive hyperemia was induced following upper arm occlusion and the PAT-ratio between baseline and hyperemia was calculated. The patients were followed for cardiovascular events (revascularization, acute coronary syndrome, ischemic stroke, cardiovascular death, repeat coronary angiography due to chest pain) for 44±14 months. The first event was included in the combined end point. Results: The study cohort was divided according to the median PAT-ratio (1.91). The combined end point occurred in 14 patients with a PAT-ratio below the median (1.91) and in 12 patients with a PAT-ratio of ≥ 1.91 (p= 0.65). In a subgroup of 76 patients, the PAT-ratio was reassessed after six months. No differences in the event rate were found between the patients who exhibited deterioration (n = 50) and those who exhibited an improvement in the PAT-ratio of ＞0.1 (n = 26; 22 vs. 32%, p = 0.32). The combined end point occurred earlier in the patients with a PAT-ratio within the 1st tertile than in those with a PAT-ratio within the 2nd/3rd tertile (11.3±11.0 vs. 27.5±18.6 months, p= 0.03). Conclusions: In patients with established CAD or a high cardiovascular risk profile, the PAT-ratio cannot be used to predict the risk of future cardiovascular events. However, a lower PAT-ratio may be associated with the earlier occurrence of cardiovascular events. J Atheroscler Thromb, 2014; 21:230-238.

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Endothelial dysfunction measured by peripheral arterial tonometry predicts prognosis in patients with heart failure with preserved ejection fraction

Cited by 56 publications

References 25 publications

Microvascular endothelial dysfunction in heart failure with preserved ejection fraction

Microvascular endothelial dysfunction in heart failure with preserved ejection fraction

Evidence of microvascular dysfunction in heart failure with preserved ejection fraction

Prognostic Value of Peripheral Arterial Tonometry in Patients with Coronary Artery Disease and a High Cardiovascular Risk Profile

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