Deep Phenotyping of Systemic Arterial Hemodynamics

Authors: Julio A Chirinos

Publish Date: 2017/02/16

Volume: 10, Issue: 3, Pages: 245-259

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Abstract

A better understanding of the pathophysiology of heart failure with a preserved left ventricular ejection fraction HFpEF is important Detailed phenotyping of pulsatile hemodynamics has provided important insights into the pathophysiology of left ventricular remodeling and fibrosis diastolic dysfunction microvascular disease and impaired oxygen delivery to peripheral skeletal muscle all of which contribute to exercise intolerance the cardinal feature of HFpEF Furthermore arterial pulsatile hemodynamic mechanisms likely contribute to the frequent presence of comorbidities such as renal failure and dementia in this population Our therapeutic approach to HFpEF can be enhanced by clinical phenotyping tools with the potential to “segment” this population into relevant pathophysiologic categories or to identify individuals exhibiting prominent specific abnormalities that can be targeted by pharmacologic interventions This review describes relevant technical and physiologic aspects regarding the deep phenotyping of arterial hemodynamics in HFpEF In an accompanying review the potential of this approach to enhance our clinical and therapeutic approach to HFpEF is discussedThe author has received consulting honoraria from BristolMyers Squibb OPKO Healthcare Fukuda Denshi Microsoft Vital Labs and Merck He received research grants from the National Institutes of Health American College of Radiology Network American Heart Association Fukuda Denshi BristolMyers Squibb Microsoft and CVRx Inc and device loans from AtCor Medical He is named as inventor in a University of Pennsylvania patent application for the use of inorganic nitrates/nitrites for the treatment of Heart Failure and Preserved Ejection Fraction

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