Studies of vascular function in patients with heart failure and either preserved or reduced left ventricular systolic function

摘要: Up to 50% of patients with the clinical syndrome heart failure have preserved left ventricular systolic function (HF-PSF). Invasive studies utilising cardiac catheterisation demonstrated that HF-PSF abnormalities (LV) relaxation and filling, or LV diastolic dysfunction. As a result, it has been proposed dysfunction is primary pathophysiological process in HF-PSF. However, population-based shown there poor correlation between presence failure. This controversy led search for alternative processes which could potentially cause There are some data suggest combination dysfunction, ‘LV stiffness’, large artery stiffness, when compared normal subjects systemic hypertension. implies interaction ventricle vasculature dysfunctional potential Although limited on arterial stiffness HF-PSF, no examining other parameters vascular never formally cohorts due reduced (HF-RSF). The presented this thesis were designed further characterise compare HF-RSF control subjects. I used non-invasive techniques assess function, such as endothelial function. also evaluated venous namely capacitance function. Arterial measured by aortic pulse wave velocity (PWV), was significantly elevated both groups, implying indeed associated greater stiffness. In contrast, waveform analysis failed show any significant differences derived compliance three study may be fact all groups matched underlying coronary disease, reducing ability technique differentiate groups. Using Laser Doppler iontophoresis, impaired microvascular responses acetylcholine sodium nitroprusside. suggests that, rather than being solely disorder tone reflects smooth muscle It not certain if and/or secondary inflammatory neurohumoral activation syndrome, factor development either form failure. As regards had lower (but similar controls). Increased represent compensatory response less marked absent HF-RSF. Venous Aellig dorsal hand vein technique. technically possible complete an whole patient cohort, resulting fewer available analysis. Despite this, appeared venodilatation acetylcholine, controls, although apparent difference statistically significant. While conclusive, they abnormal The finding indicate process, conclude supports hypothesis increased likely result ventriculo-vascular coupling. important