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J Card Fail. 2016 Jan;22(1):3-11. doi: 10.1016/j.cardfail.2015.09.003. Epub 2015 Sep 18.

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

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Faculté Libre de Médecine, GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Université Catholique de Lille, Université Lille Nord de France, Lille, France.
Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, Louisiana, USA.
Centre Hospitalier Universitaire de Lille and Faculté de Médecine, Université Lille Nord de France, Lille, France.
Division of Cardiovascular Surgery, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva Hemodynamic Research Group, Geneva, Switzerland.
Centre Hospitalier Universitaire de Lille and Faculté de Médecine, Université Lille Nord de France, Lille, France; Department of Cardiology, Centre Hospitalier Universitaire de Grenoble, Grenoble, France. Electronic address:



Assessment of vascular endothelial function lacks consistency, and microvascular endothelial function has been only partly assessed in heart failure with preserved ejection fraction (HFpEF).


The 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.


Brachial 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).


Compared with hypertensive control subjects, patients with HFpEF had a depressed endothelial function in the forearm vasculature and microvasculature.


Heart failure with preserved ejection fraction; arterial stiffness; echocardiography; microcirculation; vascular function

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