Clinical assessment of endothelial function in heart failure with preserved ejection fraction: A meta‐analysis with meta‐regressions

Background Endothelial dysfunction is a key mechanism in the development of cardiac remodelling and diastolic dysfunction in heart failure with preserved ejection fraction (HFpEF). Flow‐mediated (FMD) and nitrate‐mediated dilation (NMD) are noninvasive methods to assess endothelial function. We performed a meta‐analysis evaluating the impact of HFpEF on FMD and NMD. Methods PubMed, Web of Science, Scopus and EMBASE databases were systematically searched according to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Differences were expressed as mean difference (MD) with 95% confidence intervals (95%CI). The random effects method was used. Results A total of seven studies were included in the final analysis, 7 with data on FMD (326 HFpEF patients and 417 controls) and 3 on NMD (185 HFpEF patients and 271 controls). Compared to controls, HFpEF patients showed significantly lower FMD (MD: −1.929; 95%CI: −2.770, −1.088; P