Document Detail


Diastolic relaxation and compliance reserve during dynamic exercise in heart failure with preserved ejection fraction.
MedLine Citation:
PMID:  21478380     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Recent studies have examined haemodynamic changes with stressors such as isometric handgrip and rapid atrial pacing in heart failure with preserved ejection fraction (HFpEF), but little is known regarding left ventricular (LV) pressure-volume responses during dynamic exercise.
OBJECTIVE: To assess LV haemodynamic responses to dynamic exercise in patients with HFpEF.
METHODS: Twenty subjects with normal ejection fraction (EF) and exertional dyspnoea underwent invasive haemodynamic assessment during dynamic exercise to evaluate suspected HFpEF.
RESULTS: LV end-diastolic pressure was elevated at rest (>15 mm Hg, n=18) and with exercise (≥20 mm Hg, n=20) in all subjects, consistent with HFpEF. Heart rate (HR), blood pressure, arterial elastance and cardiac output increased with exercise (all p<0.001). Minimal and mean LV diastolic pressures increased by 43-56% with exercise (both p<0.0001), despite a trend towards a reduction in LV end-diastolic volume (p=0.08). Diastolic filling time was abbreviated with increases in HR and the proportion of diastole that elapsed prior to estimated complete relaxation increased (p<0.0001), suggesting inadequate relaxation reserve relative to the shortening of diastole. LV diastolic chamber elastance acutely increased 50% during exercise (p=0.0003). Exercise increases in LV filling pressures correlated with changes in diastolic relaxation rates, chamber stiffness and arterial afterload but were not related to alterations in preload volume, HR or cardiac output.
CONCLUSION: In patients with newly diagnosed HFpEF, LV filling pressures increase during dynamic exercise in association with inadequate enhancement of relaxation and acute increases in LV chamber stiffness. Therapies that enhance diastolic reserve function may improve symptoms of exertional intolerance in patients with hypertensive heart disease and early HFpEF.
Authors:
Barry A Borlaug; Wissam A Jaber; Steve R Ommen; Carolyn S P Lam; Margaret M Redfield; Rick A Nishimura
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2011-04-08
Journal Detail:
Title:  Heart (British Cardiac Society)     Volume:  97     ISSN:  1468-201X     ISO Abbreviation:  Heart     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-05-18     Completed Date:  2011-07-27     Revised Date:  2013-09-16    
Medline Journal Info:
Nlm Unique ID:  9602087     Medline TA:  Heart     Country:  England    
Other Details:
Languages:  eng     Pagination:  964-9     Citation Subset:  AIM; IM    
Affiliation:
Cardiovascular Division, The Mayo Clinic College of Medicine, Rochester, MN 55905, USA. borlaug.barry@mayo.edu
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MeSH Terms
Descriptor/Qualifier:
Aged
Cardiac Catheterization
Compliance / physiology
Diastole
Dyspnea / etiology
Exercise / physiology*
Female
Heart Failure / physiopathology*
Hemodynamics / physiology*
Humans
Male
Middle Aged
Stroke Volume / physiology
Ventricular Dysfunction, Left / physiopathology
Grant Support
ID/Acronym/Agency:
HL84907/HL/NHLBI NIH HHS; T32 HL007111/HL/NHLBI NIH HHS; U01 HL084907/HL/NHLBI NIH HHS
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