Flow-Mediated Vasodilation and Reactive Hyperemia Index in Heart Failure with Reduced or Preserved Ejection Fraction

Abstract

Vascular endothelial dysfunction is part of the underlying pathophysiology of heart failure. However, there are no reports in which vascular endothelial function of both conduit arteries and microvasculature was assessed in patients with heart failure. This study was aimed to assess vascular endothelial function separately in heart failure with reduced (HFrEF) and preserved ejection fraction (HFpEF). We performed simultaneous measurement of both flow-mediated vasodilation for endothelial function of conduit arteries and reactive hyperemia-peripheral arterial tonometry for that of microvasculature in 88 consecutive patients with chronic heart failure. In 55 patients with ischemic heart disease as an underlying cause of heart failure, flow-mediated vasodilation value was comparable between the two groups of HFrEF (left ventricular ejection fraction < 50%, n = 31) and HFpEF (left ventricular ejection fraction ≥ 50%, n = 24). Reactive hyperemia index measured by reactive hyperemia peripheral arterial tonometry, however, was lower in HFrEF patients compared to HFpEF patients (P = 0.014). In contrast, among 33 patients with non-ischemic heart disease, the degree of flow-mediated vasodilation was lower in HFpEF patients (n = 18) compared with HFrEF patients (n = 15) (P = 0.009), while reactive hyperemia index was comparable between the two groups. The clinical and pathophysiological significance of endothelial function in heart failure differs between conduit artery and microvasculature, and these differences may contribute to the underlying pathophysiology of HFpEF and HFrEF, as well as in ischemic heart disease and non-ischemic heart disease.

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

“…Several studies reported a lower hyperaemic response after 5 min occlusion of the brachial vasculature in HFpEF patients compared to matched control subjects [ 24 , 26 , 28 , 29 ], which was associated with worse outcome [ 25 ]. However, HFpEF patients showed a better digital hyperaemic response than HFrEF patients [ 27 ]. Impaired endothelium-independent vasodilation was also shown in the forearm skin in coronary artery disease patients with HFpEF compared with patients without HF [ 11 ].…”

Endothelial Dysfunction and Heart Failure with Preserved Ejection Fraction—An Updated Review of the Literature

“…In contrast, in non-ischaemic patients, the degree of FMD was lower in HFpEF patients compared to HFrEF patients (p = 0.009), whereas the RHI was similar in the two groups. These results suggest that the clinical significance of FMD and RHI measurements in patients with HF may diverge depending on the concomitant presence of coronary disease, rather than on the HF phenotype based on EF [56].…”

Effects of dulaglutide on endothelial progenitor cells and arterial elasticity in patients with type 2 diabetes mellitus

“…Therefore, it is necessary to further explore the effect of dulaglutide on peripheral blood EPCs and arterial elasticity in non-obese T2DM patients or T2DM patients with ASCVD. (3) Reactive hyperaemia index (RHI) and flow-mediated vasodilation (FDM) are valuable indexes to evaluate vascular endothelial function and predict the prognosis of cardiovascular disease [ 56 ]. Due to conditional limitations, we did not measure RHI and FDM while determining baPWV in subjects.…”