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1 Internal Medicine- Cardiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
2 Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
3 Internal Medicine-Cardiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
4 Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
5 Duke University, Raleigh, North Carolina, United States
6 Winston-Salem, North Carolina, United States; Internal Medicine-Cardiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
7 Radiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
8 Wake Forest University School of Medicine; Internal Medicine-Cardiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States; Wake Forest University School of Medicine, United States; Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
9 Internal Medicine-Cardiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States; Winston-Salem, North Carolina, United States
* To whom correspondence should be addressed. E-mail: ghundley{at}wfubmc.edu.
Abstract Background: Flow mediated arterial dilation (FMAD), an indicator of endothelial function, is reduced in patients with heart failure and reduced left ventricular ejection fraction (HFREF). Many elderly patients with heart failure exhibit a normal left ventricular ejection fraction (HFNEF). It is unknown whether if FMAD is severely reduced in the elderly with HFNEF. Methods & Results: Thirty participants >60 years of age, 11 healthy, 9 with HFNEF, and 10 with HFREF, underwent a cardiovascular magnetic resonance (CMR) assessment of FMAD in the superficial femoral artery followed within 48 hours by symptom-limited exercise with expired gas analysis. Elderly patients with HFREF and HFNEF had severely reduced peak oxygen consumption [VO2 peak] 12 ± 2 and 13 ± 1 ml/kg/min, respectively) versus their healthy age-matched contemporaries (20 ±3 ml/kg/min). FMAD was 3.8 ± 1.3% (0.85 +/- 0.22 mm2) in patients with HFREF; it was 12.1 ± 3.6% (3.1 ± 1.2mm2) and 13.7 ± 5.9% (3.9 ± 1.7 mm2) respectively, in patients with HFNEF and in age-matched healthy older individuals. After adjusting for age and gender, the association of FMAD with VO2 was high in healthy and HFREF subjects (p=0.05 and 0.02, respectively), but less so in HFNEF participants (p=0.58). Conclusions: Elderly patients with HFNEF do not exhibit marked reduction in leg flow mediated arterial dilation. These data suggest that mechanisms other than impaired femoral arterial endothelial function contribute to the severe exercise intolerance experienced by these individuals.
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  D. W. Kitzman Diastolic Dysfunction: One Piece of the Heart Failure With Normal Ejection Fraction Puzzle Circulation, April 22, 2008; 117(16): 2044 - 2046. [Full Text] [PDF]
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