The enormous and rapidly growing burden of Heart Failure with Preserved Ejection Fraction
(HFpEF) has led to a need to understand the pathogenesis and treatment options for this
morbid disease. Recent research from the investigator's group and others have shown that
pulmonary hypertension (PH) is highly prevalent in HFpEF, and right ventricular (RV)
dysfunction is present in both early and advanced stages of HFpEF.
These abnormalities in the RV and pulmonary vasculature are coupled with limitations in
pulmonary vasodilation during exercise. There are no therapies directly targeted at the
pulmonary vasculature that have been clearly shown to be effective in HFpEF. A recent study
by Mayo Clinic Investigators has demonstrated pulmonary vasodilation with dobutamine (a beta
2 agonist) in HFpEF. As an intravenous therapy, this is not feasible for outpatient use.
In the proposed randomized, placebo-controlled double blinded trial, the investigators seek
to evaluate whether the commonly used inhaled bronchodilator albuterol (a beta 2 agonist),
administered through a high-efficiency nebulizer device that achieves true alveolar drug
delivery, improves pulmonary vascular resistance (PVR) at rest and during exercise in
patients with HFpEF as compared to placebo. This has the potential to lead to a simple cost
effective intervention to improve symptoms in HFpEF, and potentially be tested in other World
Health Organization (WHO) Pulmonary Hypertension groups. PVR is an excellent surrogate marker
for pulmonary vasodilation and has been used in previous early trials of PH therapy.