Role of endothelial dysfunction in heart failure

Cinzia Zuchi, Isabella Tritto, Erberto Carluccio, Cristian Mattei, Gaia Cattadori, Giuseppe Ambrosio

Research output: Contribution to journalReview articlepeer-review


Coronary artery disease is a major underlying etiology for heart failure. The role of coronary microvascular disease, and endothelial dysfunction, in the pathophysiology of heart failure is poorly appreciated. Endothelial dysfunction, induced by oxidative stress, contributes to the development of heart failure. Alterations of endothelial function and nitric oxide-cyclic guanosine monophosphate (NO-cGMP) pathway are involved in the pathophysiology of heart failure with both reduced and preserved ejection fraction. Indeed, an altered endothelium dependent vasodilatation, causing repeated episodes of ischemia/reperfusion, can induce a chronic stunned myocardium with systolic dysfunction and an increased diastolic stiffness with diastolic dysfunction. Moreover, the altered NO-cGMP pathway directly affects myocardial homeostasis. Endothelial dysfunction is associated with worse prognosis and higher rate of cardiovascular events. Potential therapeutic strategies targeting the NO-cGMP pathway in patients with HF will be discussed in this review article. Although clinical data are still inconclusive, the NO-cGMP pathway represents a promising target for therapy.

Original languageEnglish
Pages (from-to)21-30
Number of pages10
JournalHeart Failure Reviews
Issue number1
Publication statusPublished - Jan 1 2020


  • Endothelial dysfunction
  • Heart failure
  • Microcirculation
  • Nitric oxide

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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