Abstract:
BACKGROUND:Aortic stiffening and reduced nitric oxide (NO) availability may contribute to the pathophysiology of heart failure with preserved ejection fraction (HFpEF). OBJECTIVES:This study compared indices of arterial stiffness at rest and during exercise in subjects with HFpEF and hypertensive control subjects to examine their relationships to cardiac hemodynamics and determine whether exertional arterial stiffening can be mitigated by inorganic nitrite. METHODS:A total of 22 hypertensive control subjects and 98 HFpEF subjects underwent hemodynamic exercise testing with simultaneous expired gas analysis to measure oxygen consumption. Invasively measured radial artery pressure waveforms were converted to central aortic waveforms by transfer function to assess integrated measures of pulsatile aortic load, including arterial compliance, resistance, elastance, and wave reflection. RESULTS:Arterial load and wave reflections in HFpEF were similar to those in control subjects at rest. During submaximal exercise, HFpEF subjects displayed reduced total arterial compliance and higher effective arterial elastance despite similar mean arterial pressures in control subjects. This was directly correlated with higher ventricular filling pressures and depressed cardiac output reserve (both p < 0.0001). With peak exercise, increased wave reflections, impaired compliance, and increased resistance and elastance were observed in subjects with HFpEF. A subset of HFpEF subjects (n = 52) received sodium nitrite or placebo therapy in a 1:1 double-blind, randomized fashion. Compared to placebo, nitrite decreased aortic wave reflections at rest and improved arterial compliance and elastance and central hemodynamics during exercise. CONCLUSIONS:Abnormal pulsatile aortic loading during exercise occurs in HFpEF independent of hypertension and is correlated with classical hemodynamic derangements that develop with stress. Inorganic nitrite mitigates arterial stiffening with exercise and improves hemodynamics, indicating that arterial stiffening with exercise is at least partially reversible. Further study is required to test effects of agents that target the NO pathway in reducing arterial stiffness in HFpEF. (Study of Exercise and Heart Function in Patients With Heart Failure and Pulmonary Vascular Disease [EXEC]; NCT01418248. Acute Effects of Inorganic Nitrite on Cardiovascular Hemodynamics in Heart Failure With Preserved Ejection Fraction; NCT01932606. Inhaled Sodium Nitrite on Heart Failure With Preserved Ejection Fraction; NCT02262078).
journal_name
J Am Coll Cardioljournal_title
Journal of the American College of Cardiologyauthors
Reddy YNV,Andersen MJ,Obokata M,Koepp KE,Kane GC,Melenovsky V,Olson TP,Borlaug BAdoi
10.1016/j.jacc.2017.05.029subject
Has Abstractpub_date
2017-07-11 00:00:00pages
136-148issue
2eissn
0735-1097issn
1558-3597pii
S0735-1097(17)37422-3journal_volume
70pub_type
杂志文章,随机对照试验abstract:OBJECTIVES:This study was undertaken to elucidate the prevalence of aortic valve abnormalities in the elderly. BACKGROUND:The age of persons treated actively for valve disorders is increasing. More information is needed about the prevalence of aortic valve disease in old age. METHODS:Randomly selected men and women i...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(93)90249-z
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abstract:OBJECTIVES:We examined compliance with performance measures for 14,464 patients enrolled from July 2008 through June 2009 into the American College of Cardiology's PINNACLE (Practice Innovation And Clinical Excellence) program to provide initial insights into the quality of outpatient cardiac care. BACKGROUND:Little i...
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abstract::In 26 consecutive cases with acquired immunodeficiency syndrome (AIDS) the main cardiac findings were Kaposi's sarcoma in 2 cases, microfocal myocardial abscess in 1, subendocardial infarct necrosis in 2, contraction band necrosis in 13, lymphocytic myocarditis in 9, intramyocardial lymphocytic infiltrates without myo...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(88)90420-2
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abstract::The development of gestational diabetes and even milder forms of dysglycemia during pregnancy represents a maternal phenotype at increased subsequent risk for developing type 2 diabetes mellitus, metabolic syndrome, and, with time, overt cardiovascular disease. A careful and systematic dissection of the hormonal, meta...
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pub_type: 杂志文章,评审
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更新日期:2013-08-20 00:00:00
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更新日期:1998-06-01 00:00:00
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更新日期:2004-01-07 00:00:00
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更新日期:2018-08-14 00:00:00
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更新日期:2016-10-11 00:00:00
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更新日期:2014-04-01 00:00:00
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更新日期:2012-01-03 00:00:00
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更新日期:1993-10-01 00:00:00