Document Detail

Abnormalities of diastolic function as a potential cause of exercise intolerance in chronic heart failure.
MedLine Citation:
PMID:  1967559     Owner:  NLM     Status:  MEDLINE    
Most research in the field of chronic heart failure during the last 20 years has been directed toward defining and understanding the abnormalities of systolic function seen in this disorder, but systolic performance is not a determinant of effort tolerance. Several lines of evidence, however, suggest a strong relation between exercise capacity and abnormalities of diastolic function in chronic heart failure. Of all the commonly measured hemodynamic variables, effort tolerance (whether limited by dyspnea or fatigue) varies more closely with the level of left ventricular filling pressure than the left ventricular ejection fraction. Consequently, drugs that lower ventricular filling pressures are more likely to enhance exercise capacity than drugs that primarily increase cardiac output and left ventricular ejection phase indexes. Vasodilator drugs do not reduce left ventricular filling pressure, however, by simply redistributing central blood volume to the peripheral capacitance circuits because these agents do not predictably decrease left ventricular volumes. Instead, clinically effective drugs seem to reduce left ventricular filling pressure primarily by producing a favorable shift in the left ventricular diastolic pressure-volume relation. Conversely, agents that adversely affect the diastolic pressure-volume relation frequently cause clinical deterioration. These findings suggest that abnormalities of diastolic rather than systolic performance may be the most important determinants of the clinical status and exercise intolerance of patients with chronic heart failure.
M Packer
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.; Review    
Journal Detail:
Title:  Circulation     Volume:  81     ISSN:  0009-7322     ISO Abbreviation:  Circulation     Publication Date:  1990 Feb 
Date Detail:
Created Date:  1990-03-13     Completed Date:  1990-03-13     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  III78-86     Citation Subset:  AIM; IM    
Department of Medicine, Mount Sinai School of Medicine, City University of New York, NY 10029.
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MeSH Terms
Adrenergic beta-Antagonists / therapeutic use
Angiotensin-Converting Enzyme Inhibitors / therapeutic use
Calcium Channel Blockers / therapeutic use
Diuretics / therapeutic use
Exercise / physiology*
Heart Failure / drug therapy,  physiopathology*
Myocardial Contraction / physiology*
Phosphodiesterase Inhibitors / therapeutic use
Physical Exertion / physiology
Pulmonary Wedge Pressure / physiology
Stroke Volume / physiology
Vasodilator Agents / therapeutic use
Grant Support
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Angiotensin-Converting Enzyme Inhibitors; 0/Calcium Channel Blockers; 0/Diuretics; 0/Phosphodiesterase Inhibitors; 0/Vasodilator Agents

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