Elderly patients with HFNEF exhibited preserved leg flow-mediated arterial dilation (12.1%) similar to healthy controls (13.7%), whereas it was severely reduced in HFREF patients (3.8%).
Cross-Sectional (n=30)
Is flow-mediated arterial dilation severely reduced in elderly patients with heart failure and normal left ventricular ejection fraction compared to healthy controls and HFREF patients?
Elderly patients with HFNEF do not exhibit marked reduction in leg FMAD, suggesting other mechanisms contribute to their severe exercise intolerance.
Absolute Event Rate: 12.1% vs 13.7%
BACKGROUND: flow-mediated arterial dilation (FMAD), an indicator of endothelial function, is reduced in patients with heart failure and reduced left ventricular ejection fraction (HFREF). Many elderly patients with heart failure exhibit a normal left ventricular ejection fraction (HFNEF). It is unknown whether FMAD is severely reduced in the elderly with HFNEF. METHODS AND RESULTS: 30 participants >60 yr of age, 11 healthy, 9 with HFNEF, and 10 with HFREF, underwent a cardiovascular magnetic resonance (CMR) assessment of FMAD in the superficial femoral artery followed within 48 h by symptom-limited exercise with expired gas analysis. Elderly patients with HFREF and HFNEF had severely reduced peak oxygen consumption (Vo(2 peak); 12 +/- 2 and 13 +/- 1 ml.kg(-1).min(-1), respectively) vs. their healthy age-matched contemporaries (20 +/- 3 ml.kg(-1).min(-1)). FMAD was 3.8 +/- 1.3% (0.85 +/- 0.22 mm(2)) in patients with HFREF; it was 12.1 +/- 3.6% (3.1 +/- 1.2 mm(2)) and 13.7 +/- 5.9% (3.9 +/- 1.7 mm(2)), respectively, in patients with HFNEF and age-matched healthy older individuals. After adjustment for age and gender, the association of FMAD with Vo(2) was high in healthy and HFREF subjects (P = 0.05 and 0.02, respectively) but less so in HFNEF participants (P = 0.58). CONCLUSIONS: elderly patients with HFNEF do not exhibit marked reduction in leg FMAD. These data suggest that mechanisms other than impaired femoral arterial endothelial function contribute to the severe exercise intolerance experienced by these individuals.
Hundley et al. (2006) conducted a cross-sectional in Heart failure (n=30). Heart failure with normal ejection fraction (HFNEF) vs. Healthy age-matched individuals was evaluated on Leg flow-mediated arterial dilation (FMAD). Elderly patients with HFNEF exhibited preserved leg flow-mediated arterial dilation (12.1%) similar to healthy controls (13.7%), whereas it was severely reduced in HFREF patients (3.8%).