Hey #cardiotwitter, here’s a thread on my latest publication “Endothelial dysfunction and cellular repair in #HFpEF: response to a maximal #exercise bout” in #EJHF @ESC_Journals @mross013 @AnastasiaSMihai @DrWillWatson @GiuseppeGalati_ @rudolf_deboer doi.wiley.com/10.1002/ejhf.1…
I’ve previously presented parts of this at #EuroPrevent 2018 YIA session and @KeystoneSymp so you can stop here if you attended 😉 #EAPC @SilCastelletti @FlavioDascenzi @merrylindseyphd @mmamas1973 @HH4EHRA @lamcardio @rladeiraslopes @verocornelissen @paolo_emilio @m_piepoli
This is the first time I do this so feedback is very much appreciated! Let’s structure this as follows:
-What did we investigate?
-What were the results?
-Why is this important?
-What did we investigate?
-What were the results?
-Why is this important?
So first: what did we do? You probably know that the #endothelium plays a big role in development of #HFpEF– if not, here’s the seminal Paulus & Tschöpe paper from 2013 explaining that. sciencedirect.com/science/articl… 
In this study we determined the number of endothelial progenitor cells (EPC) and angiogenic T cells (TA) in #HFpEF patients. EPC and TA participate in repair of the endothelium, so could be important to ‘fix’ endothelial damage in HFpEF.
My boss Emeline Van Craenenbroeck has done some great work on EPC and TA in #HeartFailure with reduced EF – she and others (@mross013) found out that #exercise acutely mobilizes these cells & improves their function dx.doi.org/10.1016/j.ijca…
This might be one of the reasons #exercise is so good for #HeartFailure patients. So we wanted to know if this happens in #HFpEF too!
We recruited 26 #HFpEF patients and 26 age- and sex-matched healthy volunteers free from CV disease. Mean age was 74 ±7 years so you can guess it was hard to find these volunteers 😉
All patients and volunteers did a maximal exercise test, and we measured microvascular endothelial function (EndoPAT) and EPC and TA count (Flow cytometry) before and after exercise.
What were the results? At baseline, HFpEF patients had worse microvascular endothelial function (p=0.036). This is actually no new info (Borlaug et al JACC 2010), but it’s in line with the Paulus hypothesis.
We also saw that #HFpEF patients had lower EPC and TA counts (p=0.025 and p=0.047). This could explain the worse endothelial function you say? But alas there was NO correlation between EPC, TA and endothelial function…
Now to the measurements after exercise. In healthy subjects exercise actually worsened their endothelial function! HFpEF is unchanged, if you put the graphs together you can nicely see that healthy folks reduce the PAT ratio to the level of the HFpEF patients.
We know that in healthy subjects, the acute oxidative stress of exercise reduces endothelial function, but it’s a controversial issue. See this interesting CrossTalk debate in @JPhysiol - doi.wiley.com/10.1113/JP2747…
EPCs did not significantly change with exercise. TA, however, were recruited to the circulation both in HFpEF and healthy subjects. The magnitude of recruitment seems a lot smaller in HFpEF, but the interaction term is totally not significant here.
So what do we learn from this?
-HFpEF patients have microvascular endothelial dysfunction
-Lower EPC and TA counts suggest deficient endothelial repair in HFpEF
-Exercise acutely increases TA in healthy and HFpEF subjects alike
-HFpEF patients have microvascular endothelial dysfunction
-Lower EPC and TA counts suggest deficient endothelial repair in HFpEF
-Exercise acutely increases TA in healthy and HFpEF subjects alike
Why is this important? In HFpEF patients, acute exercise doesn’t seem to have any further negative effects on the endothelium. It will be interesting to see what training (repeated exercise) does! (Guess what: I’m looking into that already 😄)
The role of TA is interesting as well. They were upregulated by exercise and correlated with less severe NYHA class. Maybe these could be a therapeutic target in HFpEF – if only we knew how to upregulate them…
So thanks for your attention and hope you though it's interesting!
