measurement of endothelial function and cardiac output: new methods

Conditions: Heart Failure; Hypertension, Pulmonary; Hypertension; Diabetic Nephropathies

Summary: the main purpose of this study is to analyse test-retest-reliability of functional quantification of endothelial dysfunction through puls-amplitude-tonometry in patients with heart failure with preserved/reduced ejection fraction, pulmonary hypertension, arterial hypertension and diabetic nephropathy. in the same group, test-retest-reliability of circulating endothelial cells as well as test-retest reliability of non invasive cardiac output monitoring will be observed and analysed.


Eligibility criteria:
inclusion criteria: * clinically stable for the last 4 weeks (not for hfref: 7 days) * signed consent form hfpef: * baseline-echocardiography: * hospitalization \ 8 or e' \< 8 cm/s or * bnp \>= 100pg/ml or nt-probnp \>= 300pg/ml in the last 6 months or * lavi \> 28 ml/m² and e/e' \> 8 or e' \ 40mmhg and e/e' \> 8 or e' \< 8 cm/s * possibility to take part in cardiac stress test * heart failure nyha i-iii * sinus rhythm * max. o2-uptake on exertion \< 20ml/kgbw/min hfref * hfref due to ischemic or non-ischemic reasons * nyha i-iii * individually optimized and stable pharmacological therapy (including beta-blocker, ace-inhibitor, at1-antagonist, aldosterone-antagonist) * ef \<=45%, simpson biplan ph * nice-classification 2013 i/ii * pah \>= 25 mmhg * precapillary pah: wedge-pressure \<= 15 mmhg, co normal or low * postcapillary pah: wedge-pressure \>= 15 mmhg, co normal or low diabetic nephropathy: * diabetes mellitus type 2 with oral or insulin therapy and one or more of the following: * diabetic nephropathy has been diagnosed before (anamnesis) * macroalbuminuria: urine albumine/creatinine-ratio \> 300mg/g creatinine (\>34mg/mmol) in 2 out of 3 tests of urine in the morning and gfr \<90ml/min/1.73m² (ckd-epi) * microalbuminuria: 30-300mg/g creatinine (\>=3.4 mg/mmol but \<34mg/mmol) tested as above and gfr \< 90 ml/min/1.73m² and diabetic retinopathy ah: * hypertension diagnosed at least 6 months except structural heart disease: ef \> 55% and no sign of hfpef * no symptoms of coronary heart disease * possibility to take part in cardiac stress test * stable pharmacologic therapy of hypertension for at least 4 weeks * systolic blood pressure \<140 mmhg during screening exclusion criteria: * patient incapable of contracting * angina pectoris \> ccs ii * coronary intervention in the last 4 weeks or scheduled intervention/bypass * myocardial infarction in the last 3 months * stroke in the last 3 months * valvular heart disease \> ii° * cardiomyopathy due to infiltrate/hypertrophic obstruction (e.g. hocm, amyloidosis) * congenital complex heart disease * active myocarditis * significant lung disease * significant cardiac dysrhythmia * scheduled changes in medication during time of study * (scheduled) heart transplant * cardiac resynchronisation therapy over the last three months * icd/pacemaker-implant in the last 4 weeks * uncontrolled hyper/hypotension (\>180mmhg, \<95mmhg) * patient taking part in rehabilitation program * diagnosed malignant disease or disease with life expectancy \< 1 year * anemia with hb\<10mg/dl * untreated significant thyroid disease hfpef, hypertension and ph: * patient incapable of cardiac stress test (e.g. because of orthopedic problems) * significant changes in cardiovascular status over the two weeks of study * instable cardiopulmonary status over the last four weeks hfref: * i.v. treatment with inotropic drug or diuretic in the last 7 days before screening * myocardial infarction in the last 4 weeks

Keywords: endopat nicom circulating endothelial cells