Document Detail


Heart failure with preserved ejection fraction in outpatients with unexplained dyspnea: a pressure-volume loop analysis.
MedLine Citation:
PMID:  20394874     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: The aim of the present study was to diagnose heart failure with preserved ejection fraction (HFPEF) in outpatients with unexplained chronic dyspnea and to elucidate its underlying mechanisms in this population using invasive pressure-volume loop analysis. BACKGROUND: The diagnosis of HFPEF in stable outpatients with unexplained dyspnea is difficult. METHODS: Thirty patients (age 67 +/- 8.6 years, 27% males) with preserved left ventricular (LV) ejection fraction (>50%) and unexplained chronic New York Heart Association functional class II to III dyspnea underwent heart catheterization. Patients with significant coronary artery stenosis (>50%) were excluded. Pressure-volume loops were assessed using a conductance catheter at rest, hand-grip exercise, leg lifting, and nitroprusside and dobutamine infusion. RESULTS: Twenty (66%) patients showed LV end-diastolic pressure >16 mm Hg (HFPEF), whereas the remaining 10 patients served as controls. Patients with HFPEF had significantly higher end-diastolic stiffness (0.205 +/- 0.074 vs. 0.102 +/- 0.017, p < 0.001) at rest, and their end-diastolic pressure-volume relationship showed a consistent upward and leftward shift during all hemodynamic interventions compared with controls. Regarding the underlying mechanism of HFPEF, 14 (70%) patients had markedly increased end-diastolic stiffness, which was considered a sufficient single pathology to induce increased LV end-diastolic pressure. Four (20%) patients showed a concomitant presence of moderately increased stiffness and severe LV dyssynchrony, and the remaining 2 (10%) patients, with normal stiffness, showed significant exercise-induced mitral regurgitation at hand-grip exercise. If the invasive pressure measurements were absent, only 5 (25%) of the outpatients with HFPEF fulfilled the European Society of Cardiology definition of HFPEF. CONCLUSIONS: A significant proportion of stable outpatients with unexplained chronic dyspnea may have HFPEF. In the patients whom we studied, increased LV stiffness, dyssynchrony, and dynamic mitral regurgitation were the major mechanisms underlying development of HFPEF.
Authors:
Martin Penicka; Jozef Bartunek; Helena Trakalova; Hana Hrabakova; Michaela Maruskova; Jiri Karasek; Viktor Kocka
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  55     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2010 Apr 
Date Detail:
Created Date:  2010-04-16     Completed Date:  2010-06-15     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1701-10     Citation Subset:  AIM; IM    
Copyright Information:
Copyright (c) 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Affiliation:
Cardiovascular Center Aalst, Aalst, Belgium. martin.penicka@olvz-aalst.be
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MeSH Terms
Descriptor/Qualifier:
Aged
Diagnosis, Differential
Diastole
Disease Progression
Dyspnea / diagnosis*,  etiology,  physiopathology
Echocardiography, Doppler, Pulsed
Exercise Test
Female
Follow-Up Studies
Heart Catheterization
Heart Failure / complications,  diagnosis,  physiopathology*
Humans
Male
Outpatients*
Severity of Illness Index
Stroke Volume / physiology*
Ventricular Function, Left / physiology*
Ventricular Pressure / physiology*
Comments/Corrections
Comment In:
J Am Coll Cardiol. 2010 Apr 20;55(16):1711-2   [PMID:  20394875 ]

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