The Role of Systemic Microvascular Dysfunction in Heart Failure with Preserved Ejection Fraction

Weerts, Jerremy; Mourmans, Sanne G J; Aizpurua, Arantxa Barandiarán; Schroen, Blanche; Knackstedt, Christian; Eringa, Etto C.; Houben, Alfons J.H.M.; Empel, Vanessa van

doi:10.3390/biom12020278

Cited by 15 publications

(12 citation statements)

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“…Moreover, a decrease in coronary microvascular function, an increased prevalence in coronary rarefaction, and an impaired maximal hyperemia, compared to age-matched controls, were also reported in HFpEF patients ( 25 – 28 ). For a more comprehensive review on this subject, see Weerts et al, ( 29 ).…”

Section: Vascular Contribution To Hfpefmentioning

confidence: 99%

A potential role of autophagy-mediated vascular senescence in the pathophysiology of HFpEF

et al. 2022

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Heart failure with preserved ejection fraction (HFpEF) is one of the most complex and most prevalent cardiometabolic diseases in aging population. Age, obesity, diabetes, and hypertension are the main comorbidities of HFpEF. Microvascular dysfunction and vascular remodeling play a major role in its development. Among the many mechanisms involved in this process, vascular stiffening has been described as one the most prevalent during HFpEF, leading to ventricular-vascular uncoupling and mismatches in aged HFpEF patients. Aged blood vessels display an increased number of senescent endothelial cells (ECs) and vascular smooth muscle cells (VSMCs). This is consistent with the fact that EC and cardiomyocyte cell senescence has been reported during HFpEF. Autophagy plays a major role in VSMCs physiology, regulating phenotypic switch between contractile and synthetic phenotypes. It has also been described that autophagy can regulate arterial stiffening and EC and VSMC senescence. Many studies now support the notion that targeting autophagy would help with the treatment of many cardiovascular and metabolic diseases. In this review, we discuss the mechanisms involved in autophagy-mediated vascular senescence and whether this could be a driver in the development and progression of HFpEF.

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Section: Vascular Contribution To Hfpefmentioning

confidence: 99%

A potential role of autophagy-mediated vascular senescence in the pathophysiology of HFpEF

et al. 2022

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“…По этой причине механизмы и пути развития КМД становятся объектом изучения конкретных фармакологических мишеней, таких как оксид азота, саркомерный титин, трансформирующий фактор роста β, цитокины или аденозиновые рецепторы, воздействие на которые могло бы предотвратить развитие и прогрессирование эндотелиальной дисфункции, лежащей в основе развития данного состояния [4][5][6][7]. Тем не менее, остаются открытыми многие вопросы, а полученные новые данные по-прежнему не могут быть использованы для оптимизации терапевтических стратегий лечения, и необходимо дальнейшее изучение этой непростой, с экспоненциально растущим интересом к ней, проблемы [8].…”

Section: актуальностьunclassified

“…Это, с одной стороны, ухудшает физиологию эндотелия и периваскулярной среды, запуская сложные молекулярные пути, которые в конечном итоге приводят к развитию периваскулярного фиброза, повышенной миокардиальной жёсткости и снижению CFR [7]. С другой стороны, данные патофизиологические механизмы опосредуют прогрессирование гипоксии в тканях, что локально инициирует высвобождение воспалительных цитокинов, которые, в свою очередь, способствуют формированию интерстициального фиброза, тем самым запуская патологический круг микроциркуляторных изменений в миокарде [8,9].…”

Section: материал и методы исследованияunclassified

The role of microvascular dysfunction in the pathogenesis of heart failure with preserved efficiency fraction

et al. 2022

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Background. The results of a growing number of international studies support the assumption that the prevalence of coronary microvascular dysfunction is much higher than previously thought, including in patients with heart failure with preserved ejection fraction. Aim. To study the role of coronary microvascular dysfunction in the pathogenesis of heart failure with preserved ejection fraction in patients with non-obstructive lesions of the coronary arteries. Material and methods. The study included 73 patients with non-obstructive lesions of the coronary arteries. Dynamic single-photon emission computed tomography was used to evaluate the parameters of coronary blood flow reserve. Coronary microvascular dysfunction was defined as the presence of reduced coronary blood flow reserve 2. The distribution of patients was carried out depending on the reserve of coronary blood flow: the first group (n=35) included patients with a reduced reserve 2, the second group with preserved reserve 2 (n=38). Statistical processing of the study results was carried out using nonparametric methods: in the analysis of quantitative indicators, the MannWhitney test was used; in the analysis of qualitative features, the analysis of contingency tables using the Pearson 2 test was performed. To search for relationships between variables, correlation analysis with the calculation of Spearman's correlation coefficients was used. Results. In 82.9% of cases, patients in the first group had heart failure, while in patients in the second group, it was diagnosed only in 44.7% of cases (p=0.014). The values of the coronary blood flow reserve correlated with the size of the left atrium (r=0.527; p=0.001), the E/A (r=0.321, p=0.012) and E/e' ratio (r=0.307; p=0.021). In patients with heart failure, the levels of coronary blood flow reserve correlated with the functional class: in patients with functional class I (n=21), the values of this indicator were 2.87 (2.52; 2.94), with class II (n=8) 1.98 (1.65; 2.16), with functional class III (n=17) 1.51 (1.23; 1.69). Conclusion. The presence of coronary microvascular dysfunction is associated with a higher incidence of heart failure with preserved ejection fraction; values of coronary blood flow reserve correlate with parameters of diastolic dysfunction.

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“…Even if the arterial AH is one of the most frequent causes of HFpEF, it is not clear if it is similar to those observed in hypertensive patients, such as the changes in micro-and macro-vascular structure which could be observed in HFpEF patients. Recent studies separately showed that HFpEF is associated with detrimental changes in retinal microcirculation and carotid arteries [15][16][17][18]. However, to our knowledge, no previous study has simultaneously evaluated retinal, carotid and left ventricle remodeling in patients with HFpEF.…”

Section: Introductionmentioning

confidence: 98%

Remodeling of Retinal Arterioles and Carotid Arteries in Heart Failure Development—A Preliminary Study

Sadowski

Targoński

Cygański

et al. 2022

JCM

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Current data indicate that heart failure (HF) is associated with inflammation and microvascular dysfunction and remodeling. These mechanisms could be involved in HF development and progression, especially in HF with preserved ejection fraction (HFpEF). We aimed to compare structural changes in retinal arterioles and carotid arteries between HF patients and patients without heart failure. This preliminary, retrospective, case-control study included 28 participants (14 patients with HFpEF and 14 age- and sex-matched healthy controls). Carotid intima-media thickness to lumen ratio (cIMTLR) was assessed using B-mode ultrasonography. Retinal arterioles wall- to-lumen ratio (rWLR) was assessed by adaptive optics camera rtx1. The HF patients had higher IMTLR (Dmedian [HFpEF–control group] 0.07, p = 0.01) and eWLR (Dmedian 0.03, p = 0.001) in comparison to patients without HF. In the whole study group, rWLR correlated significantly with IMTLR (r = 0.739, p = 0.001). Prevalence of arterial hypertension was similar in both groups, however, patients with HF had a significantly lower office, central and 24-hour ambulatory blood pressure (systolic Dmedian −21 to −18 mmHg; diastolic Dmedian −23 to −10 mmHg). Our data suggests gradual and simultaneous progression of vascular remodeling in both retinal arterioles and carotid arteries in HFpEF patients. This process could be a marker of HF development. Significantly lower blood pressure values in HF group may indicate that vascular remodeling could be independent of BP control. Nevertheless, further and larger prospective studies allowing to reduce the impact of confounding and address temporality are warranted.

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The Role of Systemic Microvascular Dysfunction in Heart Failure with Preserved Ejection Fraction

Cited by 15 publications

References 208 publications

A potential role of autophagy-mediated vascular senescence in the pathophysiology of HFpEF

A potential role of autophagy-mediated vascular senescence in the pathophysiology of HFpEF

The role of microvascular dysfunction in the pathogenesis of heart failure with preserved efficiency fraction

Remodeling of Retinal Arterioles and Carotid Arteries in Heart Failure Development—A Preliminary Study

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The Role of Systemic Microvascular Dysfunction in Heart Failure with Preserved Ejection Fraction

Cited by 15 publications

References 208 publications

A potential role of autophagy-mediated vascular senescence in the pathophysiology of HFpEF

A potential role of autophagy-mediated vascular senescence in the pathophysiology of HFpEF

The role of microvascular dysfunction in the pathogenesis of heart failure with preserved ­efficiency fraction

Remodeling of Retinal Arterioles and Carotid Arteries in Heart Failure Development—A Preliminary Study

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The role of microvascular dysfunction in the pathogenesis of heart failure with preserved efficiency fraction