Microvascular dysfunction across organs in heart failure with preserved ejection fraction: the PROSE-HFpEF case-control study
Authors' conclusion
HFpEF patients showed microvascular differences versus controls across all vascular beds studied. However, confounder-adjusted differences remained significant in eyes and kidneys. The findings across multiple organs support that MVD is likely a more systemic process than only local MVD in HFpEF, and possible sex-specific underlying pathophysiology.
Study context
- Population
- Subjects ≥ 60years; Heart failure with preserved ejection fraction (HFpEF) patients and controls without HF
- Participants
- 138 vs 2,140
- Comparison
- HFpEF patients vs controls without HF
- HFpEFn = 138
- Controlsn = 2,140reference
- Outcome
- Confounder-adjusted microvascular differences across vascular beds
Methodological detailsprospective, confounder-adjusted
- Prospective
- Confounder-adjusted
Main finding
As reported in the abstract
- HFpEF vs Controls · narrower CRVE with HFpEF
- difference in CRVE - 8.1 μm; P = 0.008
- HFpEF vs Controls · narrower CRAE trend with HFpEF
- difference in CRAE - 3.5 μm; P = 0.073
- HFpEF vs Controls · similar
- flicker-light-induced retinal venular dilation - 0.23 %; P = 0.392
- HFpEF vs Controls · similar
- flicker-light-induced retinal arteriolar dilation - 0.18 %; P = 0.593
- Between HFpEF and Controls · similar
- skin endothelial flowmotion power - 0.09 log(PU2); P = 0.181
- Between HFpEF and Controls · similar
- heat-induced hyperemia 0.02 log(%); P = 0.605
- HFpEF vs Controls · higher with HFpEF
- Urinary albumin-to-creatinine ratio (UACR) 0.56 log(g/mol); P = < 0.001
Observational data: associations, not effects.
Further findings
CRVE by sex (interaction analysis, confounder-adjusted)
- Female patients had narrower CRVE vs controls
- - 13.8 μm, p < 0.001
- Males, CRVE patients vs controls
- 1.2 μm, p = 0.812
- Interaction with sex
- pint=0.023
Skin endothelial flowmotion power by diabetes status (interaction analysis, confounder-adjusted)
- Patients had lower skin endothelial flowmotion power only when diabetes was co-occurring
- - 0.36 log(PU2 ), p = 0.014
- Interaction with diabetes
- pint=0.048
UACR by sex (interaction analysis)
- UACR higher in male and female patients vs controls, more pronounced in males
- pint=0.002
Original publication
Microvascular dysfunction across organs in heart failure with preserved ejection fraction: the PROSE-HFpEF case-control study. Cardiovasc Diabetol. Published 30 July 2025. doi:10.
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