Endothelial function in patients with heart failure with preserved ejection fraction undergoing multicomponent drug therapy

Objective. To study endothelial vasomotor function (EVF) of brachial artery (BA) and microcirculatory arteries (MCA) in patients with HFpEF receiving multicomponent drug therapy (MDT). Material and methods. The study included 34 patients with HFpEF aged 74±9 years. There were 11 (32%) men and 23 (68%) women. All patients received MDT according to clinical guidelines. EVF of BA was assessed according to standard method by Celermajer D.S. on expert-level ultrasound system Philips IU22 (Netherlands) with linear sensor 5—12 MHz. EVF of MCA was assessed using finger photoplethysmography in reactive hyperemia test (“Angioscan 01” device). Results. There was endothelial dysfunction of BA (flow-mediated dilation (FMD) <8%) in 64% and endothelial dysfunction of MCA (amplitude occlusion index (AI) <2.0) in 44% of patients with HFpEF. EVF of BA and MCA did not correlate with each other, and there was no consistency between endothelial dysfunction in different vascular levels. Negative correlations were found between FMD and age, NT-proBNP and E/e′ ratio (r=-0.5, p=0.003; r=-0.4, p=0.042; r=-0.5, p=0.008, respectively). AI negatively correlated with BMI (r=-0.43, p=0.016). Intake of acetylsalicylic acid (ASA) was associated with significantly better EVF. Patients taking ASA had no endothelial dysfunction of MCA or severe endothelial dysfunction of BA (FMD <4%). FMD was 9.0% (7.3; 13.3) vs. 5.2% (1.9; 7.7) (p=0.008) compared to patients not taking ASA, despite comparability in other parameters. Conclusion. Endothelial dysfunction of BA was found in 64% of patients with HFpEF receiving MDT. It was associated with diastolic myocardial dysfunction. Microvascular endothelial dysfunction is detected in 44% of cases and associated with BMI. No relationship was found between EVF of BA and MCA. Intake of ASA is associated with significantly better EVF. This association needs to be clarified in larger samples and prospective studies.