Flow-mediated dilation and heart failure: a review with implications to physical rehabilitation

Abstract

Endothelial dysfunction plays as an important role on mismatch responses that occur during exercise in patients with congestive heart failure (CHF). However, cardiac rehabilitation, a core component of management of CHF patients, can improve endothelial function, contributing to reduce the morbidity and mortality of these patients. The primary aims of this review were to describe the importance of flow-mediated dilatation (FMD) as a non-invasive validation tool to assess endothelial dysfunction and to highlight the relevance of scientific studies that evaluated the effects of exercise interventions on peripheral vascular endothelial function as measured by FMD in patients with CHF with both preserved and reduced ejection fraction.

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

“…Considering HFpEF as a multisystem disease with endothelial dysfunction representing the key mechanism of such systemic maladaptation, targeting endothelial function has been recently proposed as a new appealing approach for future HFpEF therapies. 8,13 It has been reported that exercise is able to increase blood flow and shear stress, thus positively impacting NO bioavailability and endothelial function. 58 Moreover, exercise may induce changes to the adrenergic system in addition to its ability to recruit endothelial progenitor cells from the bone marrow.…”

“…10 In detail, a systemic pro-inflammatory state with increased oxidative stress and subsequent endothelial dysfunction have been proposed as key mechanisms in the development of cardiac remodelling and left ventricular (LV) diastolic dysfunction in HFpEF patients. 11,12 Thus, due to its systemic nature and reversibility in early stages, endothelial dysfunction may represent an attractive therapeutic target in this clinical setting, 13,14 with a potential emerging role for exercise training and cardiac rehabilitation in HFpEF patients. 15,16 Among a number of available techniques, brachial artery flow-mediated dilation (FMD) and nitrate-mediated dilation (NMD) are recognized as accurate and noninvasive methods for estimating endothelial function by means of ultrasound (US) imaging.…”

Impedance plethysmography-based method in the assessment of subclinical atherosclerosis

“…the body's local nitric oxide (NO) bioavailability in the endothelium. Thus, impairment in FMD in pre-clinical subjects is related to a number of risk factors [3], and a reduction in FMD is predictive for a cardiovascular disease [8]. However, clear additional prognostic value for endothelial function has not been found [9].…”

Shear stress‐induced flow‐mediated dilatation: is it up to haemoglobin?

“…During periods of increased perfusion, where the v of blood increases, endothelial cells release nitric oxide to stimulate arterial smooth muscle vasorelaxation, a process known as flow mediated dilatation (FMD). Importantly, FMD is a prognostic indicator of future cardiovascular disease (Areas et al 2019) and is quantified clinically during ischaemia-reperfusion testing. The magnitude of FMD (i.e.…”