Tohoku J. Exp. Med., 2020 September, 252 (1)

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

RYUTARO WAKU,¹ SEIKO TOKOI,¹ SHIGERU TOYODA,¹ KEIJIRO KITAHARA,¹ JIN NAGANUMA,¹ HIROKO YAZAWA,¹ MASASHI SAKUMA,¹ SHICHIRO ABE,¹ TOSHIAKI NAKAJIMA¹ and TERUO INOUE¹

¹Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine, Mibu, Tochigi, Japan

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 ge; 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.

Keywords —— heart failure; heart failure with preserved ejection fraction; heart failure with reduced ejection fraction; ischemic heart disease; vascular endothelial function

© 2020 Tohoku University Medical Press

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Tohoku J. Exp. Med., 2020 , 252, 85-93.

Correspondence: Shigeru Toyoda, M.D., Ph.D., Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi 321-0293, Japan.

e-mail: s-toyoda@dokkyomed.ac.jp