Leg flow-mediated arterial dilation in elderly patients with heart failure and normal left ventricular ejection fraction

Hundley, W. Gregory; Bayram, Ersin; Hamilton, Craig; Hamilton, Eric A.; Morgan, Timothy M.; Darty, Stephen; Stewart, Kathryn P.; Link, Kerry M.; Herrington, David M.; Kitzman, Dalane W.

doi:10.1152/ajpheart.00567.2006

Cited by 84 publications

(88 citation statements)

References 39 publications

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“…Other factors -both cardiac and extracardiac -including increased arterial stiffness, altered ventricular-arterial coupling [42,43], endothelial dysfunction, reduced vasodilator reserve [44,45] and chronotropic incompetence [46,47] have been recently implicated in the pathophysiology of this complex syndrome. Furthermore, coexisting abnormalities in LV regional systolic function assessed by various parameters have been documented in HFpEF [13,15,17,18,[48][49][50].…”

Section: Pathophysiologymentioning

confidence: 99%

“…Combined ventricular and arterial stiffening leads to a system that is vulnerable to minor changes in preload or afterload with exaggerated swings in blood pressure [88]. These effects are further amplified during exercise where increased preload, further elevations in filling pressures and impaired reduction of afterload (due to a blunted vasodilator response to exercise) collectively contribute to exercise intolerance [44,45,47]. Exercise-induced elevation of pulmonary artery pressure and the ensuing elevation of right-sided pressures may contribute to poor functional capacity secondary to ventricular interdependence and increased pericardial constraint [43,89,90].…”

Section: Venrticular-arterial Coupling and Endothelial Dysfunctionmentioning

confidence: 99%

“…Abnormalities in each of these components have been identified in HFpEF with blunted exercise-induced increases in preload, blunted increases in ejection fraction, contractility and regional systolic function, impaired chronotropic reserve (i.e. chronotropic incompetence) and attenuated exercise-mediated vasodilatation being documented in several studies [15,16,18,41,42,[44][45][46][47]50,64,[92][93][94][95]. Recent studies have also reported increased prevalence of diastolic dyssynchrony in patients with HFpEF [96][97][98].…”

Section: Global Cardiovascular Reserve Dysfunctionmentioning

confidence: 99%

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Heart Failure with Preserved Ejection Fraction

Čulić

2017

N Engl J Med

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Heart failure with preserved ejection fraction (HFpEF) has recently emerged as a major cause of cardiovascular morbidity and mortality. Contrary to initial beliefs, HFpEF is now known to be as common as heart failure with reduced ejection fraction (HFrEF) and carries an unacceptably high mortality rate. With a prevalence that has been steadily rising over the past two decades, it is very likely that HFpEF will represent the dominant heart failure phenotype over the coming few years. The scarcity of trials in this semi-discrete form of heart failure and lack of unified enrolment criteria in the studies conducted to date might have contributed to the current absence of specific therapies. Understanding the epidemiological, pathophysiological and molecular differences (and similarities) between these two forms of heart failure is cornerstone to the development of targeted therapies. Carefully designed studies that adhere to unified diagnostic criteria with the recruitment of appropriate controls and adoption of practical end-points are urgently needed to help identify effective treatment strategies.

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Section: Pathophysiologymentioning

confidence: 99%

Section: Venrticular-arterial Coupling and Endothelial Dysfunctionmentioning

confidence: 99%

Section: Global Cardiovascular Reserve Dysfunctionmentioning

confidence: 99%

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Heart Failure with Preserved Ejection Fraction

Čulić

2017

N Engl J Med

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“…5,71 Patients with heart failure suffer from a severely reduced quality of life due to their exercise intolerance and associated inability to perform daily activities. [72][73][74][75][76] Such adverse effects, however, can be ameliorated by exercise training.…”

Section: Heart Failurementioning

confidence: 99%

High-Intensity Interval Training Versus Moderate-Intensity Continuous Training in the Prevention/Management of Cardiovascular Disease

Hussain

Macaluso

Pearson

2016

Cardiology in Review

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“…It is worth noting that systemic vasodilation with exercise has been reported to be impaired in some, but not all, studies of HFNEF. 113,115 Borlaug et al…”

Section: 66mentioning

confidence: 99%

Hypertension and heart failure: a dysfunction of systole, diastole or both?

et al. 2008

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The pathological myocardial hypertrophy associated with hypertension contains the seed for further maladaptive development. Increased myocardial oxygen consumption, impaired epicardial coronary perfusion, ventricular fibrosis and remodelling, abnormalities in long-axis function and torsion, cause, to a varying degree, a mixture of systolic and diastolic abnormalities. In addition, chronotropic incompetence and peripheral factors such as lack of vasodilator reserve and reduced arterial compliance further affect cardiac output particularly on exercise. Many of these factors are common to hypertensive heart failure with a normal ejection fraction as well as systolic heart failure. There is increasing evidence that these apparently separate phenotypes are part of a spectrum of heart failure differing only in the degree of ventricular remodelling and volume changes. Furthermore, dichotomizing heart failure into systolic and diastolic clinical entities has led to a paucity of clinical trials of therapies for heart failure with a normal ejection fraction. Therapies aimed at reversing myocardial fibrosis, and targets outside the heart such as enhancing vasodilator reserve and improving chronotropic incompetence deserve further study and may improve the exercise capacity of hypertensive heart failure patients. Hypertension heart disease with heart failure is simply not a dysfunction of systole and diastole. Other peripheral factors including heart rate and vasodilator response with exercise may deserve equal attention in an attempt to develop more effective treatments for this disorder.

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Leg flow-mediated arterial dilation in elderly patients with heart failure and normal left ventricular ejection fraction

Abstract: elderly patients with HFNEF do not exhibit marked reduction in leg FMAD. These data suggest that mechanisms other than impaired femoral arterial endothelial function contribute to the severe exercise intolerance experienced by these individuals.

Cited by 84 publications

References 39 publications

Heart Failure with Preserved Ejection Fraction

Heart Failure with Preserved Ejection Fraction

High-Intensity Interval Training Versus Moderate-Intensity Continuous Training in the Prevention/Management of Cardiovascular Disease

Hypertension and heart failure: a dysfunction of systole, diastole or both?

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