PMID- 21543374
OWN - NLM
STAT- MEDLINE
DCOM- 20111110
LR  - 20220321
IS  - 1879-0844 (Electronic)
IS  - 1388-9842 (Linking)
VI  - 13
IP  - 7
DP  - 2011 Jul
TI  - Microvascular tissue perfusion is impaired in acutely decompensated heart failure 
      and improves following standard treatment.
PG  - 711-7
LID - 10.1093/eurjhf/hfr043 [doi]
AB  - AIMS: Acutely decompensated heart failure (ADHF) leads to neurohumoral activation 
      potentially affecting vascular tone and organ perfusion and may be linked to 
      unfavourable outcome. Global haemodynamic, clinical, and laboratory parameters 
      may severely underestimate tissue hypoperfusion. Therefore, the purpose of this 
      study was to evaluate microvascular flow index (MFI) in patients with ADHF and to 
      assess the effect of standard pharmacological therapy using Sidestream Dark Field 
      (SDF) imaging. METHODS AND RESULTS: Twenty-seven patients (mean age 75.5 +/- 10.1 
      years, 48% male) with ADHF in New York Heart Association functional class >/=III 
      were included. Serum markers of neurohumoral activation [brain natriuretic 
      peptide (BNP)], endothelin-1 (ET-1), noradrenaline (NA), and echocardiographic 
      parameters of left ventricle-function were determined at hospital admission and 
      the day before discharge. Using SDF imaging, MFI was evaluated at both 
      time-points in semi-quantitative vessel categories (small: 10-25 mum; medium: 
      26-50 mum; and large: 51-100 mum). At admission, increased serum levels of BNP, NA, 
      and ET-1 and a severely reduced MFI were observed in association with ADHF. Serum 
      levels of BNP, NA, and ET-1 decreased significantly with standard pharmacological 
      therapy (BNP: 2163 +/- 1577 vs.1006 +/- 945 pg/mL, P< 0.05; NA: 349 +/- 280 to 318 +/- 
      265 pg/mL, P< 0.05; ET-1: 5.08 +/- 0.72 to 4.81 +/- 0.59 pg/mL; P< 0.01). Standard 
      pharmacological treatment also had a profound impact on tissue perfusion by 
      significantly improving median MFI in small [2.6; inter-quartile range (IQR) 
      2.3-2.9 vs. 2.9; IQR 2.8-3.0; P= 0.01) and medium-sized (2.0; IQR 1.9-2.5 vs. 
      2.7; IQR 2.5-2.8; P< 0.01) vessels. CONCLUSION: In patients with ADHF, 
      microvascular tissue perfusion is impaired even when global haemodynamic or 
      laboratory signs of hypoperfusion are absent. Effective pharmacological treatment 
      to decrease neurohumoral activation significantly improves microflow. 
      Hypoperfusion in ADHF is potentially linked to neurohumoral activation with 
      increased plasma levels of vasoconstrictors and sympatho-adrenergic activity.
FAU - Lauten, Alexander
AU  - Lauten A
AD  - Department of Internal Medicine I (Cardiology, Angiology, Pneumology), 
      Friedrich-Schiller University, Erlanger Allee 101, Jena, Germany. 
      alexander.lauten@med.uni-jena.de
FAU - Ferrari, Markus
AU  - Ferrari M
FAU - Goebel, Bjoern
AU  - Goebel B
FAU - Rademacher, Wilma
AU  - Rademacher W
FAU - Schumm, Julia
AU  - Schumm J
FAU - Uth, Olivia
AU  - Uth O
FAU - Kiehntopf, Michael
AU  - Kiehntopf M
FAU - Figulla, Hans R
AU  - Figulla HR
FAU - Jung, Christian
AU  - Jung C
LA  - eng
PT  - Journal Article
DEP - 20110504
PL  - England
TA  - Eur J Heart Fail
JT  - European journal of heart failure
JID - 100887595
RN  - 0 (Adrenergic beta-Antagonists)
RN  - 0 (Angiotensin Receptor Antagonists)
RN  - 0 (Angiotensin-Converting Enzyme Inhibitors)
RN  - 0 (Endothelin-1)
RN  - 0 (Sodium Potassium Chloride Symporter Inhibitors)
RN  - 114471-18-0 (Natriuretic Peptide, Brain)
RN  - 27O7W4T232 (Spironolactone)
RN  - X4W3ENH1CV (Norepinephrine)
SB  - IM
MH  - Adrenergic beta-Antagonists/therapeutic use
MH  - Aged
MH  - Angiotensin Receptor Antagonists/therapeutic use
MH  - Angiotensin-Converting Enzyme Inhibitors/therapeutic use
MH  - Disease Progression
MH  - Endothelin-1/blood
MH  - Female
MH  - Heart Failure/blood/drug therapy/*physiopathology
MH  - Hemodynamics/physiology
MH  - Humans
MH  - Male
MH  - Microcirculation/physiology
MH  - Myocardial Perfusion Imaging/instrumentation/*methods
MH  - Natriuretic Peptide, Brain/blood
MH  - Norepinephrine/blood
MH  - Prognosis
MH  - Regional Blood Flow
MH  - Sodium Potassium Chloride Symporter Inhibitors/therapeutic use
MH  - Spironolactone/therapeutic use
MH  - Statistics, Nonparametric
MH  - Stroke Volume
MH  - Ventricular Function, Left
EDAT- 2011/05/06 06:00
MHDA- 2011/11/11 06:00
CRDT- 2011/05/06 06:00
PHST- 2011/05/06 06:00 [entrez]
PHST- 2011/05/06 06:00 [pubmed]
PHST- 2011/11/11 06:00 [medline]
AID - hfr043 [pii]
AID - 10.1093/eurjhf/hfr043 [doi]
PST - ppublish
SO  - Eur J Heart Fail. 2011 Jul;13(7):711-7. doi: 10.1093/eurjhf/hfr043. Epub 2011 May 
      4.