{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T18:49:06Z","timestamp":1770058146788,"version":"3.49.0"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2011,7,1]],"date-time":"2011-07-01T00:00:00Z","timestamp":1309478400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2011,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>Twenty-seven patients (mean age 75.5 \u00b1 10.1 years, 48% male) with ADHF in New York Heart Association functional class \u2265III 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\u201325 \u03bcm; medium: 26\u201350 \u03bcm; and large: 51\u2013100 \u03bcm). 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 \u00b1 1577 vs.1006 \u00b1 945 pg\/mL, P&amp;lt; 0.05; NA: 349 \u00b1 280 to 318 \u00b1 265 pg\/mL, P&amp;lt; 0.05; ET-1: 5.08 \u00b1 0.72 to 4.81 \u00b1 0.59 pg\/mL; P&amp;lt; 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\u20132.9 vs. 2.9; IQR 2.8\u20133.0; P= 0.01) and medium-sized (2.0; IQR 1.9\u20132.5 vs. 2.7; IQR 2.5\u20132.8; P&amp;lt; 0.01) vessels.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eurjhf\/hfr043","type":"journal-article","created":{"date-parts":[[2011,5,4]],"date-time":"2011-05-04T21:54:43Z","timestamp":1304546083000},"page":"711-717","source":"Crossref","is-referenced-by-count":40,"title":["Microvascular Tissue Perfusion is Impaired in Acutely Decompensated Heart Failure and Improves Following Standard Treatment"],"prefix":"10.1093","volume":"13","author":[{"given":"Alexander","family":"Lauten","sequence":"first","affiliation":[{"name":"Department of Internal Medicine I (Cardiology, Angiology, Pneumology), Friedrich - Schiller University , Erlanger Allee 101, Jena, 07740 ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Markus","family":"Ferrari","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I (Cardiology, Angiology, Pneumology), Friedrich - Schiller University , Erlanger Allee 101, Jena, 07740 ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bjoern","family":"Goebel","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I (Cardiology, Angiology, Pneumology), Friedrich - Schiller University , Erlanger Allee 101, Jena, 07740 ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wilma","family":"Rademacher","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I (Cardiology, Angiology, Pneumology), Friedrich - Schiller University , Erlanger Allee 101, Jena, 07740 ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julia","family":"Schumm","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I (Cardiology, Angiology, Pneumology), Friedrich - Schiller University , Erlanger Allee 101, Jena, 07740 ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olivia","family":"Uth","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I (Cardiology, Angiology, Pneumology), Friedrich - Schiller University , Erlanger Allee 101, Jena, 07740 ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Kiehntopf","sequence":"additional","affiliation":[{"name":"Institute of Clinical Chemistry and Laboratory Medicine, Friedrich-Schiller-University , Erlanger Allee 101, Jena, 07740 ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hans R.","family":"Figulla","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I (Cardiology, Angiology, Pneumology), Friedrich - Schiller University , Erlanger Allee 101, Jena, 07740 ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Jung","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I (Cardiology, Angiology, Pneumology), Friedrich - Schiller University , Erlanger Allee 101, Jena, 07740 ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2014,2,18]]},"reference":[{"key":"2026020203303431800_ejhfhfr043-bib-0001","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1016\/j.ahj.2004.08.005","article-title":"Characteristics and outcomes of patients hospitalized for heart failure in the United States: rationale, design, and preliminary observations from the first 100,000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE)","volume":"149","author":"Adams","year":"2005","journal-title":"Am Heart J"},{"key":"2026020203303431800_ejhfhfr043-bib-0002","doi-asserted-by":"crossref","first-page":"3068","DOI":"10.1161\/01.CIR.0000039105.49749.6F","article-title":"Lifetime risk for developing congestive heart failure: the Framingham Heart Study","volume":"106","author":"Lloyd-Jones","year":"2002","journal-title":"Circulation"},{"key":"2026020203303431800_ejhfhfr043-bib-0003","doi-asserted-by":"crossref","first-page":"2725","DOI":"10.1093\/eurheartj\/ehl193","article-title":"EuroHeart Failure Survey II (EHFS II): a survey on hospitalized acute heart failure patients: description of population","volume":"27","author":"Nieminen","year":"2006","journal-title":"Eur Heart J"},{"key":"2026020203303431800_ejhfhfr043-bib-0004","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/j.pcad.2008.07.002","article-title":"The microcirculation in health and critical disease","volume":"51","author":"den Uil","year":"2008","journal-title":"Prog Cardiovasc Dis"},{"key":"2026020203303431800_ejhfhfr043-bib-0005","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1093\/eurjhf\/hfp021","article-title":"Low-dose nitroglycerin improves microcirculation in hospitalized patients with acute heart failure","volume":"11","author":"den Uil","year":"2009","journal-title":"Eur J Heart Fail"},{"key":"2026020203303431800_ejhfhfr043-bib-0006","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.ahj.2003.07.006","article-title":"Microvascular alterations in patients with acute severe heart failure and cardiogenic shock","volume":"147","author":"De Backer","year":"2004","journal-title":"Am Heart J"},{"key":"2026020203303431800_ejhfhfr043-bib-0007","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1007\/s00392-009-0018-0","article-title":"Acute microflow changes after stop and restart of intra-aortic balloon pump in cardiogenic shock","volume":"98","author":"Jung","year":"2009","journal-title":"Clin Res Cardiol"},{"key":"2026020203303431800_ejhfhfr043-bib-0008","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1016\/j.ejheart.2008.08.005","article-title":"ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European Society of Cardiology. 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