{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T21:28:15Z","timestamp":1792099695868,"version":"4.4.0"},"reference-count":93,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2023,12,24]],"date-time":"2023-12-24T00:00:00Z","timestamp":1703376000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"CardioPath programme from Federico II University, Naples, Italy"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Heart failure (HF) is a clinical syndrome consisting of typical symptoms and signs due to structural and\/or functional abnormalities of the heart, resulting in elevated intracardiac pressures and\/or inadequate cardiac output. The vascular system plays a crucial role in the development and progression of HF regardless of ejection fraction, with endothelial dysfunction (ED) as one of the principal features of HF. The main ED manifestations (i.e., impaired endothelium-dependent vasodilation, increased oxidative stress, chronic inflammation, leukocyte adhesion, and endothelial cell senescence) affect the systemic and pulmonary haemodynamic and the renal and coronary circulation. The present review is aimed to discuss the contribution of ED to HF pathophysiology\u2014in particular, HF with preserved ejection fraction\u2014ED role in HF patients, and the possible effects of pharmacological and non-pharmacological approaches. For this purpose, relevant data from a literature search (PubMed, Scopus, EMBASE, and Medline) were reviewed. As a result, ED, assessed via venous occlusion plethysmography or flow-mediated dilation, was shown to be independently associated with poor outcomes in HF patients (e.g., mortality, cardiovascular events, and hospitalization due to worsening HF). In addition, SGLT2 inhibitors, endothelin antagonists, endothelial nitric oxide synthase cofactors, antioxidants, and exercise training were shown to positively modulate ED in HF. Despite the need for future research to better clarify the role of the vascular endothelium in HF, ED represents an interesting and promising potential therapeutic target.<\/jats:p>","DOI":"10.3390\/life14010030","type":"journal-article","created":{"date-parts":[[2023,12,24]],"date-time":"2023-12-24T20:44:15Z","timestamp":1703450655000},"page":"30","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Endothelial Dysfunction and Heart Failure with Preserved Ejection Fraction\u2014An Updated Review of the Literature"],"prefix":"10.3390","volume":"14","author":[{"given":"Mariarosaria","family":"De Luca","sequence":"first","affiliation":[{"name":"Department of Translational Medical Sciences, Federico II University, 80131 Naples, Italy"},{"name":"Italian Clinical Outcome Research and Reporting Program (I-CORRP), 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Crisci","sequence":"additional","affiliation":[{"name":"Department of Translational Medical Sciences, Federico II University, 80131 Naples, Italy"},{"name":"Italian Clinical Outcome Research and Reporting Program (I-CORRP), 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9775-9715","authenticated-orcid":false,"given":"Giuseppe","family":"Armentaro","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, University Magna Gr\u00e6cia of Catanzaro, Campus Universitario di Germaneto, V.le Europa, 88100 Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1980-5728","authenticated-orcid":false,"given":"Sebastiano","family":"Cicco","sequence":"additional","affiliation":[{"name":"Internal Medicine Unit \u201cGuido Baccelli\u201d and Arterial Hypertension Unit \u201cAnna Maria Pirrelli\u201d, Department of Precision and Regenerative Medicine and Jonic Area (DiMePReJ), University of Bari Aldo Moro, Azienda Ospedaliero-Universitaria Policlinico, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Talerico","sequence":"additional","affiliation":[{"name":"Internal Medicine, Policlinico Casilino, 00169 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8287-2448","authenticated-orcid":false,"given":"Emanuele","family":"Bobbio","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden"},{"name":"Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Kuggen, 417 56 Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorena","family":"Lanzafame","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher G.","family":"Green","sequence":"additional","affiliation":[{"name":"School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abbie G.","family":"McLellan","sequence":"additional","affiliation":[{"name":"School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Radek","family":"Debiec","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, University of Leicester, Leicester (UK), IHR Leicester Biomedical Research Centre, Groby Road, Leicester LE3 9QP, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4379-5524","authenticated-orcid":false,"given":"Paolo","family":"Caferra","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, University of Pisa, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7023-3649","authenticated-orcid":false,"given":"Roberto","family":"Scicali","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Cannat\u00e0","sequence":"additional","affiliation":[{"name":"Department of Cardiology, King\u2019s College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK"},{"name":"Department of Cardiovascular Sciences, Faculty of Life Sciences & Medicine, King\u2019s College, London SE1 8WA, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1111-2780","authenticated-orcid":false,"given":"Muhammad Zubair","family":"Israr","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, University of Leicester, Leicester (UK), IHR Leicester Biomedical Research Centre, Groby Road, Leicester LE3 9QP, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8791-0167","authenticated-orcid":false,"given":"Liam M.","family":"Heaney","sequence":"additional","affiliation":[{"name":"School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2352-2103","authenticated-orcid":false,"given":"Andrea","family":"Salzano","sequence":"additional","affiliation":[{"name":"Cardiac Unit, AORN A Cardarelli, 80131 Naples, Italy"},{"name":"Cardiac Unit, University Hospital of Leicester, Glenfield Hospital, Leicester LE3 9QP, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,12,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1002\/ejhf.2333","article-title":"2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). 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