title: Effects of vasodilation in heart failure with preserved or reduced ejection fraction implications of distinct pathophysiologies on response to therapy.
abstract: OBJECTIVE
  The purpose of this study was to compare hemodynamic responses to vasodilator therapy in patients with heart failure (HF) and preserved ejection fraction (HFpEF) versus HF and reduced ejection fraction (HFrEF).
  
  
  BACKGROUND
  There is no proven therapy for HFpEF. In the absence of data, medicines with established benefit in HFrEF such as vasodilators are frequently prescribed for HFpEF.
  
  
  METHODS
  We compared baseline hemodynamics and acute responses to vasodilation with intravenous sodium nitroprusside in patients with HFrEF (n = 174) and HFpEF (n = 83), determined invasively by cardiac catheterization.
  
  
  RESULTS
  Baseline blood pressure, stroke volume, and cardiac output were greater in HFpEF than HFrEF, while pulmonary artery mean and pulmonary wedge pressures were similar. Left ventricular filling pressures were reduced to a similar extent in each group with nitroprusside, but the drop in systemic arterial pressure was 2.6-fold greater in HFpEF (p < 0.0001), and improvements in stroke volume and cardiac output were each ∼60% lower in HFpEF compared to HFrEF (p < 0.0001). Despite similarly elevated filling pressures, HFpEF patients were fourfold more likely than HFrEF to experience a reduction in stroke volume with nitroprusside (p < 0.0001), suggesting greater vulnerability to preload reduction. Pulmonary artery systolic pressure dropped more in HFpEF than in HFrEF despite similar reduction in pulmonary mean pressure and resistance, suggesting higher right ventricular systolic elastance in HFpEF.
  
  
  CONCLUSIONS
  As compared to patients with HFrEF, patients with HFpEF experience greater blood pressure reduction, less enhancement in cardiac output, and greater likelihood of stroke volume drop with vasodilators. These findings emphasize fundamental differences in the 2 HF phenotypes and suggest that more pathophysiologically targeted therapies are needed for HFpEF.
authors.affiliation: Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic Rochester, Rochester, Minnesota 55905, USA.
authors.forename: Shmuel
authors.initials: S
authors.lastname: Schwartzenberg
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Redfield
authors.forename: Aaron M
authors.initials: AM
authors.lastname: From
authors.forename: Paul
authors.initials: P
authors.lastname: Sorajja
authors.forename: Rick A
authors.initials: RA
authors.lastname: Nishimura
authors.forename: Barry A
authors.initials: BA
authors.lastname: Borlaug
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization; D004305:Dose-Response Relationship, Drug; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009599:Nitroprusside / Q000008:administration & dosage*; D011379:Prognosis; D011669:Pulmonary Wedge Pressure / Q000187:drug effects / Q000502:physiology; D012189:Retrospective Studies; D013318:Stroke Volume / Q000187:drug effects*; D014664:Vasodilation / Q000187:drug effects / Q000502:physiology*; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016278:Ventricular Function, Right / Q000187:drug effects / Q000502:physiology*
chemical_list: D014665:Vasodilator Agents; D009599:Nitroprusside