Document Detail

Excessive breathlessness in patients with diastolic heart failure.
MedLine Citation:
PMID:  16621875     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: To establish the prevalence of preserved left ventricular (LV) systolic function (PSF) in 435 consecutive symptomatic patients referred to a heart failure clinic and to examine their ventilatory response to exercise when compared with 134 control volunteers.
METHODS: 216 (50%) patients had systolic heart failure (SHF) (ejection fraction < 45%). 51 (11%) had an immediately apparent alternative causes of breathlessness and 168 (39%), with no obvious other cause of breathlessness, were divided into those with PSF and diastolic dysfunction (DD) (PSF(DD); n = 113 or 26% of referrals) and those without DD (PSF(N); n = 55 or 13% of referrals). The controls were divided into those with (C(DD); n = 32) and those without (C(N); n = 102) echocardiographic evidence of DD.
RESULTS: Patients with SHF had lower peak oxygen consumption (pVo(2)), steeper slope of minute ventilation (Ve) to carbon dioxide production, lower exercise time and shorter 6 min walk test than PSF patients and controls. PSF(DD) patients had lower pVo(2), exercise time and 6 min walk test than C(DD), although their echocardiograms were not different. Exercise capacity did not differ between PSF(DD) and PSF(N) patients. The slope relating Ve to symptoms (Borg/Ve slope) was less steep in those with SHF than in PSF(DD) (0.17 (0.04) v 0.20 (0.08), p < 0.05) and in PSF(N) (0.19 (0.10), p < 0.05), implying greater symptoms of breathlessness for a given level of Ve. Both PSF groups had a steeper slope than C(DD) (0.14 (0.09), p < 0.05 for both comparisons).
CONCLUSIONS: Patients with PSF have exercise tolerance intermediate between that of patients with SHF and controls. Exercise tolerance is similar in PSF(DD) and PSF(N). Both groups have worse exercise tolerance than C(DD). PSF(DD) and PSF(N) patients seem to experience a greater awareness of Ve than C(DD) and patients with SHF.
K K A Witte; N P Nikitin; J G F Cleland; A L Clark
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Publication Detail:
Type:  Journal Article     Date:  2006-04-18
Journal Detail:
Title:  Heart (British Cardiac Society)     Volume:  92     ISSN:  1468-201X     ISO Abbreviation:  Heart     Publication Date:  2006 Oct 
Date Detail:
Created Date:  2006-09-15     Completed Date:  2006-10-20     Revised Date:  2013-06-07    
Medline Journal Info:
Nlm Unique ID:  9602087     Medline TA:  Heart     Country:  England    
Other Details:
Languages:  eng     Pagination:  1425-9     Citation Subset:  AIM; IM    
Department of Academic Cardiology, Castle Hill Hospital, Kingston upon Hull, UK.
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MeSH Terms
Dyspnea / etiology*,  physiopathology
Echocardiography, Doppler, Pulsed
Exercise / physiology
Exercise Test
Heart Failure / complications*,  physiopathology
Oxygen Consumption / physiology
Stroke Volume / physiology
Ventricular Dysfunction, Left / etiology*,  physiopathology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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