Differences in arterial compliance, microvascular function and venous capacitance between patients with heart failure and either preserved or reduced left ventricular systolic function.
BACKGROUND
Up to 50% of patients with the clinical syndrome of heart failure have preserved left ventricular systolic function (HF-PSF). These patients may have abnormalities of ventriculo-vascular coupling, due to increased vascular and ventricular stiffness.


METHODS
We compared arterial compliance, microvascular vasodilator function and venous capacitance (VC) in 3 groups of patients (n=12 each) matched for the presence of coronary heart disease: 1) HF and preserved systolic function (HF-PSF), 2) HF and reduced systolic function (HF-RSF) and 3) controls (no HF, PSF). Arterial compliance was assessed by measuring aortic pulse wave velocity (PWV) with applanation tonometry. Cutaneous microvascular function was assessed using Laser Doppler imaging (LDI) coupled with iontophoresis of endothelium-dependent (acetylcholine) and -independent (sodium nitroprusside) vasodilators. VC was measured using venous occlusion plethysmography.


RESULTS
PWV was significantly higher in HF-PSF subjects than in both HF-RSF and control groups (10.7 [1.1], 8.9 [1.7] and 8.6 [2.1] m/s respectively, p<0.05). Acetylcholine and nitroprusside induced vasodilatation were equally impaired in HF-PSF and HF-RSF, as compared to controls (p<0.01). VC was higher in HF-RSF subjects compared with HF-PSF subjects (1.75 [0.41], 1.34 [0.34] ml/100 ml forearm vol. respectively, p<0.05).


CONCLUSIONS
These findings are consistent with a more marked increase in vascular stiffness in HF-PSF than in HF-RSF and suggest that arterial stiffness, dynamic vasodilator function and venous abnormalities may be implicated in the complex pathophysiology of HF-PSF.
Balmain
Sean
S
British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow G12 8TA, Scotland, UK. seanbalmain@hotmail.com
Padmanabhan
Neal
N
Ferrell
William R
WR
Morton
John J
JJ
McMurray
John J V
JJ
D000368:Aged; D000369:Aged, 80 and over; D001158:Arteries / Q000503:physiopathology*; D003187:Compliance; D005260:Female; D006333:Heart Failure / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008833:Microcirculation / Q000503:physiopathology*; D008875:Middle Aged; D013599:Systole; D018924:Vascular Capacitance / Q000502:physiology*; D014680:Veins / Q000503:physiopathology*; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology; D016277:Ventricular Function, Left / Q000502:physiology