Author + information
- Evelyn Santiago Vacas,
- Marta Farrero Torres,
- Isabel Blanco,
- Montserrat Cardona,
- M Ángeles Castel,
- Marta Sitges,
- Barbara Vidal,
- Joan Albert Barberà and
- Felix Perez-Villa
Pulmonary hypertension (PH) is highly prevalent and often severe in heart failure with preserved ejection fraction (HFpEF). Peripheral endothelial dysfunction (PED) has been described in patients with heart failure and depressed ejection fraction, as well as in patients with primary PH. The purpose of this study was to determine if the presence of PED is associated to PH in patients with HFpEF.
Measurements of peripheral endothelium-dependent and endothelium-independent vasoreactivity using brachial artery flow-mediated vasodilation (FMD) and nitroglycerin-mediated dilation of the brachial artery were performed in 21 patients with HFpEF and 21 hypertensive control subjects without heart failure. Patients showing pulmonary artery systolic pressure (PASP) >35 mmHg on echocardiogram were proposed to undergo a right heart catheterization.
Compared to controls, patients with HFpEF had impaired peripheral endothelial function (FMD 0.105 ± 0.03mm in HFpEF vs 0.29 ± 0.04mm in controls, p=0.002). There were no differences in nitroglycerin mediated dilation. PH was present in 16 (75%) HFpEF patients and 13 of them underwent a right heart catheterization. Their PASP was 74.15 ± 24 mmHg, pulmonary artery diastolic pressure 27.7 ± 11mmHg, pulmonary capillary wedge pressure 18.4 ± 5 mmHg, cardiac Index 2.7 ± 1 L/min/m2, pulmonary vascular resistance 6.3 ± 4 Wood Units. Subsequent analysis of the association between FMD and pulmonary vascular resistance disclosed an inverse correlation (r = −0.69, p = 0.009), showing that the less the brachial artery dilated in response to flow, the higher the pulmonary vascular resistance was.
In patients with HFpEF, there is a significant correlation between peripheral endothelial dysfunction and pulmonary vascular resistance. FMD might be a useful clinical tool for noninvasive estimation of pulmonary vasoreactivity and PH in patients with HFpEF.
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: New Paradigms in Prognostic Role of Biomarkers in Heart Failure
Abstract Category: 15. Heart Failure: Clinical
Presentation Number: 1265-304
- 2013 American College of Cardiology Foundation