Document Detail

Decreased left ventricular distensibility in response to postural change in older patients with heart failure and preserved ejection fraction.
MedLine Citation:
PMID:  20562334     Owner:  NLM     Status:  MEDLINE    
Most elderly persons with heart failure have a preserved left ventricular (LV) ejection fraction (HFPEF). The pathophysiology of this disorder is not well understood, and there are conflicting data regarding the role of decreased LV distensibility. To assess LV distensibility over a range of preload conditions while minimizing the large, confounding changes in contractility, afterload, and heart rate characteristic of exercise, we measured LV end-diastolic volume (EDV), stroke volume (SV), and cardiac output (CO) using two-dimensional echocardiography in 48 elderly (mean age, 69 yr) HFPEF patients and 25 healthy age-matched controls during quiet supine rest, 45 degrees head-up tilt (HUT), and 45 degrees head-down tilt (HDT). As a result, when compared with controls, HFPEF patients had reduced percent changes in EDV (-7 +/- 2 vs. -17 +/- 2%; P = 0.003), SV (-7 +/- 3 vs. -27 +/- 2%; P = 0.003), and CO (-6 +/- 4 vs. -34 +/- 4%; P = 0.001) during the transition from supine to HUT. HFPEF also had reduced percent changes in EDV (8 +/- 2 vs. 15 +/- 2%; P = 0.02), SV (11 +/- 3 vs. 21 +/- 3%; P = 0.002), and CO (1 +/- 4 vs. 12 +/- 4%; P = 0.04) during the transition from HUT to HDT. In conclusion, HFNEF patients have reduced LV distensibility in response to postural change, resulting in blunted EDV, SV, and CO. This provides further support for the hypothesis that a blunted Frank-Starling mechanism may contribute to the pathophysiology of HFPEF.
Jerry M John; Mark Haykowsky; Peter Brubaker; Kathy Stewart; Dalane W Kitzman
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2010-06-18
Journal Detail:
Title:  American journal of physiology. Heart and circulatory physiology     Volume:  299     ISSN:  1522-1539     ISO Abbreviation:  Am. J. Physiol. Heart Circ. Physiol.     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-08-31     Completed Date:  2010-09-22     Revised Date:  2012-05-17    
Medline Journal Info:
Nlm Unique ID:  100901228     Medline TA:  Am J Physiol Heart Circ Physiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  H883-9     Citation Subset:  IM    
Division of Cardiology, Department of Medicine, University of Toledo, Toledo, Ohio, USA.
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MeSH Terms
Chi-Square Distribution
Heart Failure / physiopathology*
Heart Ventricles / physiopathology*
Patient Selection
Posture / physiology*
Stroke Volume / physiology*
Tilt-Table Test
Ventricular Dysfunction, Left / physiopathology*
Grant Support
5T32-HL-076132-02/HL/NHLBI NIH HHS; AG-12257/AG/NIA NIH HHS; MO1-RR-07122/RR/NCRR NIH HHS; P30-AG-21332/AG/NIA NIH HHS; R37 AG018915/AG/NIA NIH HHS; R37-AG-18915/AG/NIA NIH HHS

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