Endothelial Dysfunction and Heart Failure with Preserved Ejection Fraction—An Updated Review of the Literature

• Published in: Life (Basel, Switzerland) Vol. 14; no. 1; p. 30
• Main Authors: De Luca, Mariarosaria, Crisci, Giulia, Armentaro, Giuseppe, Cicco, Sebastiano, Talerico, Giovanni, Bobbio, Emanuele, Lanzafame, Lorena, Green, Christopher G., McLellan, Abbie G., Debiec, Radek, Caferra, Paolo, Scicali, Roberto, Cannatà, Antonio, Israr, Muhammad Zubair, Heaney, Liam M., Salzano, Andrea
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 01.12.2023
• Subjects: Abnormalities; Antagonists; Atherosclerosis; Bone marrow; Cardiac output; Cardiology and Cardiovascular Disease; Cardiovascular diseases; Care and treatment; Complications and side effects; Congestive heart failure; Coronary circulation; Cytokines; Development and progression; diagnosis; Ejection fraction; Endothelial cells; endothelial dysfunction; endothelial function; Endothelins; Endothelium; Flow velocity; Health aspects; Heart diseases; Heart failure; Hemodynamics; Ischemia; Kardiologi och kardiovaskulära sjukdomar; Leukocytes; Literature reviews; Nitric oxide; Nitric-oxide synthase; Occlusion; Oxidative stress; Pathophysiology; Pharmacology; Physical training; Physiology; Plethysmography; Senescence; Shear stress; Structure-function relationships; Therapeutic targets; Tumor necrosis factor-TNF; Vascular system; Vasodilation; Veins & arteries; Italy; endothelial function; heart failure; diagnosis; endothelial dysfunction
• ISSN: 2075-1729; 2075-1729
• DOI: 10.3390/life14010030

Heart failure (HF) is a clinical syndrome consisting of typical symptoms and signs due to structural and/or functional abnormalities of the heart, resulting in elevated intracardiac pressures and/or inadequate cardiac output. The vascular system plays a crucial role in the development and progression of HF regardless of ejection fraction, with endothelial dysfunction (ED) as one of the principal features of HF. The main ED manifestations (i.e., impaired endothelium-dependent vasodilation, increased oxidative stress, chronic inflammation, leukocyte adhesion, and endothelial cell senescence) affect the systemic and pulmonary haemodynamic and the renal and coronary circulation. The present review is aimed to discuss the contribution of ED to HF pathophysiology—in particular, HF with preserved ejection fraction—ED role in HF patients, and the possible effects of pharmacological and non-pharmacological approaches. For this purpose, relevant data from a literature search (PubMed, Scopus, EMBASE, and Medline) were reviewed. As a result, ED, assessed via venous occlusion plethysmography or flow-mediated dilation, was shown to be independently associated with poor outcomes in HF patients (e.g., mortality, cardiovascular events, and hospitalization due to worsening HF). In addition, SGLT2 inhibitors, endothelin antagonists, endothelial nitric oxide synthase cofactors, antioxidants, and exercise training were shown to positively modulate ED in HF. Despite the need for future research to better clarify the role of the vascular endothelium in HF, ED represents an interesting and promising potential therapeutic target.