Document Detail

Global cardiovascular reserve dysfunction in heart failure with preserved ejection fraction.
MedLine Citation:
PMID:  20813282     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: The purpose of this study was to comprehensively examine cardiovascular reserve function with exercise in patients with heart failure and preserved ejection fraction (HFpEF).
BACKGROUND: Optimal exercise performance requires an integrated physiologic response, with coordinated increases in heart rate, contractility, lusitropy, arterial vasodilation, endothelial function, and venous return. Cardiac and vascular responses are coupled, and abnormalities in several components may interact to promote exertional intolerance in HFpEF.
METHODS: Subjects with HFpEF (n = 21), hypertension without heart failure (n = 19), and no cardiovascular disease (control, n = 10) were studied before and during exercise with characterization of cardiovascular reserve function by Doppler echocardiography, peripheral arterial tonometry, and gas exchange.
RESULTS: Exercise capacity and tolerance were reduced in HFpEF compared with hypertensive subjects and controls, with lower VO(2) and cardiac index at peak, and more severe dyspnea and fatigue at matched low-level workloads. Endothelial function was impaired in HFpEF and in hypertensive subjects as compared with controls. However, blunted exercise-induced increases in chronotropy, contractility, and vasodilation were unique to HFpEF and resulted in impaired dynamic ventricular-arterial coupling responses during exercise. Exercise capacity and symptoms of exertional intolerance were correlated with abnormalities in each component of cardiovascular reserve function, and HFpEF subjects were more likely to display multiple abnormalities in reserve.
CONCLUSIONS: HFpEF is characterized by depressed reserve capacity involving multiple domains of cardiovascular function, which contribute in an integrated fashion to produce exercise limitation. Appreciation of the global nature of reserve dysfunction in HFpEF will better inform optimal design for future diagnostic and therapeutic strategies.
Barry A Borlaug; Thomas P Olson; Carolyn S P Lam; Kelly S Flood; Amir Lerman; Bruce D Johnson; Margaret M Redfield
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  56     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-09-03     Completed Date:  2010-10-01     Revised Date:  2014-09-24    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  845-54     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Case-Control Studies
Heart Failure / physiopathology*,  ultrasonography*
Middle Aged
Stroke Volume / physiology*
Ventricular Dysfunction / physiopathology*
Grant Support
Comment In:
J Am Coll Cardiol. 2011 Mar 29;57(13):1499; author replies 1499-500   [PMID:  21435524 ]
J Am Coll Cardiol. 2010 Sep 7;56(11):864-6   [PMID:  20813284 ]

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