Pathophysiological role of oxidative stress in systolic and diastolic heart failure and its therapeutic implications
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Systolic and diastolic myocardial dysfunction has been demonstrated to be associated with an activation of the circulating and local renin–angiotensin–aldosterone system (RAAS), and with a subsequent inappropriately increased production of reactive oxygen species (ROS). While, at low concentrations, ROS modulate important physiological functions through changes in cellular signalling and gene expression, overproduction of ROS may adversely alter cardiac mechanics, leading to further worsening of systolic and diastolic function. In addition, vascular endothelial dysfunction due to uncoupling of the nitric oxide synthase, activation of vascular and phagocytic membrane oxidases or mitochondrial oxidative stress may lead to increased vascular stiffness, further compromising cardiac performance in afterload-dependent hearts. In the present review, we address the potential role of ROS in the pathophysiology of myocardial and vascular dysfunction in heart failure (HF) and their therapeutic targeting. We discuss possible mechanisms underlying the failure of antioxidant vitamins in improving patients’ prognosis, the impact of angiotensin-converting enzyme inhibitors or AT1 receptor blockers on oxidative stress, and the mechanism of the benefit of combination of hydralazine/isosorbide dinitrate. Further, we provide evidence supporting the existence of differences in the pathophysiology of HF with preserved vs. reduced ejection fraction and whether targeting mitochondrial ROS might be a particularly interesting therapeutic option for patients with preserved ejection fraction.
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Experiments using laboratory animals revealed that heart failure is accompanied by increased superoxide radical formation by NOs in vessels leading to cardiomyopathy.
“Experiments using laboratory animals revealed that heart failure is also accompanied by increased superoxide radical formation by NOs in vessels leading to cardiomyopathy (Umar and Laarse 2010; Munzel et al. 2015).”
From Reactive Oxygen Species, Toxicity, Oxidative Stress, and Antioxidants: Chronic Diseases and Aging (2023) · cites this paper as Munzel et al. 2015
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Reactive Oxygen Species, Toxicity, Oxidative Stress, and Antioxidants: Chronic Diseases and Aging
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Molecular Perspectives of Mitochondrial Adaptations and Their Role in Cardiac Proteostasis
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- Authors
- Münzel, T., Gori, T., Keaney, J. F., Maack, C., & Daiber, A.
- Affiliations
- Johannes Gutenberg University Mainz (DE)
- University of Massachusetts Chan Medical School (US)
- Universitätsklinikum des Saarlandes (DE)
- Corresponding author
- Münzel, Thomas
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2015-07-04
- Volume
- 36
- Issue
- 38
- Pages
- 2555-2564
- ISSN
- 0195-668X (ISSN-L)
- 1522-9645
- PMC
- PMC7959410
- OpenAlex
- W2119221698
- Cited by
- 394
- References
- 127
- Citations by year
- 2026: 18 · 2025: 28 · 2024: 27 · 2023: 37 · 2022: 39 · 2021: 35 · 2020: 45 · 2019: 44 · 2018: 39 · 2017: 39 · 2016: 31 · 2015: 12
- FWCI
- 4.93
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- European Heart Journal (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- NIH
- Topics
- Health Sciences › Medicine › Physiology › Nitric Oxide and Endothelin Effects
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Keywords
- oxidative stress, heart failure, systolic dysfunction, diastolic dysfunction, reactive oxygen species, renin-angiotensin-aldosterone system, endothelial dysfunction, nitric oxide synthase uncoupling, mitochondrial reactive oxygen species, vascular stiffness, antioxidant vitamins, ACE inhibitors, angiotensin receptor blockers, preserved ejection fraction, reduced ejection fraction
- MeSH terms
- Angiotensin-Converting Enzyme Inhibitors, Antioxidants, Cardiovascular System, Drug Therapy, Combination, Exercise Therapy, Humans, Hydralazine, Mitochondria, Nitrates, Nitric Oxide, Phosphodiesterase Inhibitors, Stroke Volume, Vitamins, Xanthine Oxidase, Reactive Oxygen Species, Oxidative Stress, Nitric Oxide Synthase, NADPH Oxidases, Heart Failure, Systolic, Heart Failure, Diastolic
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