Vascular and Microvascular Endothelial Function in Heart Failure With Preserved Ejection Fraction

• Vascular endothelial function is reduced in HFpEF patients compared with hypertensive control subjects matched for age, sex, and diabetes.
• Skin microvascular response to arterial occlusion is impaired in HFpEF patients compared with hypertensive control subjects matched for age, sex, and diabetes.
• Further studies are needed to evaluate whether prevention of vascular or microvascular endothelial dysfunction may delay or prevent the transition from hypertension to the syndrome of HFpEF.

BackgroundAssessment of vascular endothelial function lacks consistency, and microvascular endothelial function has been only partly assessed in heart failure with preserved ejection fraction (HFpEF).MethodsThe study population consisted of 90 patients: 45 had well documented HFpEF, and 45 had hypertension and no history or evidence of heart failure. Patients with hypertension but no heart failure were matched with HFpEF patients for age, sex, and diabetes. They served as control subjects. All patients underwent 2-dimensional Doppler echocardiography and vascular function measurements, including assessment of arterial wave reflections and arterial stiffness, brachial artery flow-mediated dilation (FMD), and forearm cutaneous blood flow with the use of a laser Doppler flow probe at rest and after release of arterial occlusion for 5 minutes.ResultsBrachial artery FMD was lower in HFpEF than in control subjects (median (IQR) 3.6 (0.4-7.4) vs 7.2 (3.2-17.2)%, P = .001). Forearm cutaneous blood flow at rest was similar in HFpEF and control subjects (P = .68). After release of arterial occlusion, forearm cutaneous peak blood flow was lower in HFpEF than in control subjects (P = .03). Estimated aortic systolic and mean blood pressures were similar in HFpEF and control subjects, whereas pulse pressure and pressure augmentation were greater in HFPEF than in control subjects (both P < .05).ConclusionCompared with hypertensive control subjects, patients with HFpEF had a depressed endothelial function in the forearm vasculature and microvasculature.