University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham B18 7QH, UK.
Eur J Heart Fail. 2012 Aug;14(8):873-81. doi: 10.1093/eurjhf/hfs066. Epub 2012 Jun 7.
The assessment of different aspects of endothelial dysfunction in cardiovascular medicine in general and in heart failure (HF) has been the focus of intense research, and includes vasomotor, haemostatic, antioxidant, and inflammatory activities. Differences also exist in the pattern of endothelial dysfunction depending on aetiology, severity, and stability of HF in individual patients. In the majority of patients with ischaemic aetiology of HF, endothelial dysfunction is systemic in its nature and involves both arteries and veins, conductance vessels and microvascular beds, coronary, pulmonary, and peripheral vessels. The pattern of endothelial dysfunction is more heterogeneous in non-ischaemic HF, with fewer features of systemic abnormalities. Indeed, many subjects with non-ischaemic HF have a functionally preserved endothelium in peripheral arteries, with endothelial dysfunction seen only in coronary vessels. Endothelial dysfunction has significant prognostic value in HF, but its clinical application is hampered by methodological limitations in its assessment. Various medications (including angiotensin-converting enzyme inhibitors and statins) and regular physical activity have been shown to improve endothelial function in HF. However, there are still no pharmaceutical agents specifically targeting the vascular endothelium. Despite the large number of studies, the pathophysiological role of the vascular endothelium and its clinical potential as a therapeutic target has not yet been sufficiently developed and undoubtedly awaits further exploration.
评估心血管医学和心力衰竭（HF）中内皮功能障碍的不同方面一直是研究的重点，包括血管舒缩、止血、抗氧化和炎症活动。根据患者的病因、HF 的严重程度和稳定性，内皮功能障碍的模式也存在差异。在大多数缺血性 HF 患者中，内皮功能障碍具有全身性，涉及动脉和静脉、传导血管和微血管床、冠状动脉、肺和外周血管。非缺血性 HF 中的内皮功能障碍模式更为异质，全身性异常特征较少。事实上，许多非缺血性 HF 患者的外周动脉内皮功能正常，仅在冠状动脉中观察到内皮功能障碍。内皮功能障碍在 HF 中有重要的预后价值，但由于其评估方法的局限性，其临床应用受到阻碍。各种药物（包括血管紧张素转换酶抑制剂和他汀类药物）和定期体育锻炼已被证明可改善 HF 中的内皮功能。然而，目前还没有专门针对血管内皮的药物。尽管进行了大量研究，但血管内皮的病理生理学作用及其作为治疗靶点的临床潜力尚未得到充分开发，无疑需要进一步探索。
