Document Detail


Characterization of static and dynamic left ventricular diastolic function in patients with heart failure with a preserved ejection fraction.
MedLine Citation:
PMID:  20682947     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Congestive heart failure in the setting of a preserved left ventricular (LV) ejection fraction is increasing in prevalence among the senior population. The underlying pathophysiologic abnormalities in ventricular function and structure remain unclear for this disorder. We hypothesized that patients with heart failure with preserved ejection fraction (HFPEF) would have marked abnormalities in LV diastolic function with increased static diastolic stiffness and slowed myocardial relaxation compared with age-matched healthy controls.
METHODS AND RESULTS: Eleven highly screened patients (4 men, 7 women) aged 73±7 years with HFPEF were recruited to participate in this study. Thirteen sedentary healthy controls (7 men, 6 women) aged 70±4 years also were recruited. All subjects underwent pulmonary artery catheterization with measurement of cardiac output, end-diastolic volumes, and pulmonary capillary wedge pressures at baseline; cardiac unloading (lower-body negative pressure or upright tilt); and cardiac loading (rapid saline infusion). The data were used to define the Frank-Starling and LV end-diastolic pressure-volume relationships. Doppler echocardiographic data (tissue Doppler velocities, isovolumic relaxation time, propagation velocity of early mitral inflow , E/A-wave ratio) were obtained at each level of cardiac preload. Compared with healthy controls, patients with HFPEF had similar LV contractile function and static LV compliance but reduced LV chamber distensibility with elevated filling pressures and slower myocardial relaxation as assessed by tissue Doppler imaging.
CONCLUSIONS: In this small, highly screened patient population with hemodynamically confirmed HFPEF, increased end-diastolic static ventricular stiffness relative to age-matched controls was not a universal finding. Nevertheless, patients with HFPEF, even when well compensated, had elevated filling pressures, reduced distensibility, and increased diastolic wall stress compared with controls. In contrast, LV relaxation as assessed by tissue Doppler variables appeared consistently impaired in patients with HFPEF.
Authors:
Anand Prasad; Jeffrey L Hastings; Shigeki Shibata; Zoran B Popovic; Armin Arbab-Zadeh; Paul S Bhella; Kazunobu Okazaki; Qi Fu; Martin Berk; Dean Palmer; Neil L Greenberg; Mario J Garcia; James D Thomas; Benjamin D Levine
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2010-08-03
Journal Detail:
Title:  Circulation. Heart failure     Volume:  3     ISSN:  1941-3297     ISO Abbreviation:  Circ Heart Fail     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-09-15     Completed Date:  2010-10-14     Revised Date:  2013-07-24    
Medline Journal Info:
Nlm Unique ID:  101479941     Medline TA:  Circ Heart Fail     Country:  United States    
Other Details:
Languages:  eng     Pagination:  617-26     Citation Subset:  IM    
Affiliation:
Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Dallas, Dallas, Tex 75231, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Analysis of Variance
Case-Control Studies
Diastole / physiology
Echocardiography, Doppler
Female
Heart Failure / physiopathology*,  ultrasonography
Hemodynamics
Humans
Linear Models
Magnetic Resonance Imaging
Male
Pulmonary Wedge Pressure
Statistics, Nonparametric
Stroke Volume / physiology*
Supine Position
Ventricular Dysfunction, Left / physiopathology*,  ultrasonography
Grant Support
ID/Acronym/Agency:
AG17479-02/AG/NIA NIH HHS; R01 AG017479/AG/NIA NIH HHS
Comments/Corrections

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