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Peer-reviewedCC BY 4.0Journal of Clinical Medicine

Impact of Chronic Heart Failure on Vascular Responsiveness: A Prospective Observational In Vivo and Ex Vivo Study in Patients Undergoing Cardiac Surgery

  • Olga Papazisi1,2
  • Marieke E. van Vessem3
  • Saskia L. M. A. Beeres4
  • Rob B. P. de Wilde5
  • Remco R. Berendsen6
  • René de Vries7
  • Bart J. A. Mertens8
  • Carlos Elzo Kraemer5
  • Jan H. N. Lindeman9
  • Robert J. M. Klautz1
  • Martin C. Michel10
  • A. H. Jan Danser7
1 more authors
  • Meindert Palmen1
10 affiliations
  1. 1Department of Cardiothoracic Surgery, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
  2. 2Department of Cardiothoracic Surgery, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
  3. 3Department of Sports Medicine, Maxima Medical Center, 5500 MB Veldhoven, The Netherlands
  4. 4Department of Cardiology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
  5. 5Department of Intensive Care, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
  6. 6Department of Anesthesiology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
  7. 7Division of Pharmacology and Vascular Medicine, Department of Internal Medicine, Erasmus MC University Medical Center, 3000 CA Rotterdam, The Netherlands
  8. 8Department of Biomedical Data Sciences, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
  9. 9Department of Vascular Surgery, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
  10. 10Department of Pharmacology, University Medical Center, Johannes Gutenberg University, 55131 Mainz, Germany
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Abstract

Background: Patients with chronic heart failure (HF) are at increased risk of vasoplegia after cardiac surgery, potentially because neurohormonal activation in the context of HF alters vascular regulation. Methods: We compared perioperative vasoresponsiveness in patients with and without HF undergoing cardiac surgery with cardiopulmonary bypass (CPB). Patients were prospectively enrolled, and changes in systemic vascular resistance (ΔSVR) after phenylephrine and nitroglycerin were measured perioperatively (in vivo). Ex vivo vasoreactivity to phenylephrine and vasopressin was tested in 40 biopsies. Results: In vivo and ex vivo analyses included 36 and 13 patients (10 controls and 3 HF patients), respectively. At baseline, phenylephrine increased SVR by 26% in HF patients (estimated marginal mean, 95% CI 16–35%) versus 51% in controls (95% CI 38–64%; p = 0.002). This attenuated response persisted during CPB, and ex vivo observations suggested a similar pattern. Responsiveness to nitroglycerin was unchanged. Lower post-CPB ΔSVR was associated with greater norepinephrine use during the first postoperative day (β = −346.6, 95% CI −541.2 to −151.9; R2 = 0.291). Conversely, HF patients showed greater ex vivo responsiveness to vasopressin. Conclusions: HF is associated with marked impairment of α1-adrenergic vasoresponsiveness, indicating impaired α1-adrenergic signaling. Preserved vasopressin responsiveness may support its earlier use for postoperative hypotension in these patients.

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Cite

BibTeXRIS
BibTeX
@article{papazisi2026impact,
  title = {{Impact of Chronic Heart Failure on Vascular Responsiveness: A Prospective Observational In Vivo and Ex Vivo Study in Patients Undergoing Cardiac Surgery}},
  author = {Olga Papazisi and Marieke E. van Vessem and Saskia L. M. A. Beeres and Rob B. P. de Wilde and Remco R. Berendsen and René de Vries and Bart J. A. Mertens and Carlos Elzo Kraemer and Jan H. N. Lindeman and Robert J. M. Klautz and Martin C. Michel and A. H. Jan Danser and Meindert Palmen},
  journal = {Journal of Clinical Medicine},
  year = {2026},
  month = oct,
  doi = {10.3390/jcm15208179},
  url = {https://www.mdpi.com/2077-0383/15/20/8179},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Impact of Chronic Heart Failure on Vascular Responsiveness: A Prospective Observational In Vivo and Ex Vivo Study in Patients Undergoing Cardiac Surgery
AU  - Olga Papazisi
AU  - Marieke E. van Vessem
AU  - Saskia L. M. A. Beeres
AU  - Rob B. P. de Wilde
AU  - Remco R. Berendsen
AU  - René de Vries
AU  - Bart J. A. Mertens
AU  - Carlos Elzo Kraemer
AU  - Jan H. N. Lindeman
AU  - Robert J. M. Klautz
AU  - Martin C. Michel
AU  - A. H. Jan Danser
AU  - Meindert Palmen
PY  - 2026
DA  - 2026/10/01
JO  - Journal of Clinical Medicine
DO  - 10.3390/jcm15208179
UR  - https://www.mdpi.com/2077-0383/15/20/8179
AB  - Background: Patients with chronic heart failure (HF) are at increased risk of vasoplegia after cardiac surgery, potentially because neurohormonal activation in the context of HF alters vascular regulation. Methods: We compared perioperative vasoresponsiveness in patients with and without HF undergoing cardiac surgery with cardiopulmonary bypass (CPB). Patients were prospectively enrolled, and changes in systemic vascular resistance (ΔSVR) after phenylephrine and nitroglycerin were measured perioperatively (in vivo). Ex vivo vasoreactivity to phenylephrine and vasopressin was tested in 40 biopsies. Results: In vivo and ex vivo analyses included 36 and 13 patients (10 controls and 3 HF patients), respectively. At baseline, phenylephrine increased SVR by 26% in HF patients (estimated marginal mean, 95% CI 16–35%) versus 51% in controls (95% CI 38–64%; p = 0.002). This attenuated response persisted during CPB, and ex vivo observations suggested a similar pattern. Responsiveness to nitroglycerin was unchanged. Lower post-CPB ΔSVR was associated with greater norepinephrine use during the first postoperative day (β = −346.6, 95% CI −541.2 to −151.9; R2 = 0.291). Conversely, HF patients showed greater ex vivo responsiveness to vasopressin. Conclusions: HF is associated with marked impairment of α1-adrenergic vasoresponsiveness, indicating impaired α1-adrenergic signaling. Preserved vasopressin responsiveness may support its earlier use for postoperative hypotension in these patients.
SN  - 2077-0383
ER  -