| Improvement in left ventricular diastolic stiffness induced by physical training in patients with dilated cardiomyopathy. | |
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MedLine Citation:
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PMID: 19398081 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Diastolic dysfunction in long-term heart failure is accompanied by abnormal neurohormonal control and ventricular stiffness. The diastolic phase is determined by a balance between pressure gradients and intrinsic ventricular wall properties: according to a mathematical model, the latter (ie, left ventricular [LV] elastance, K(LV)) may be calculated by the formula: K(LV) = (70/[DT-20])(2) mm Hg/mL, where DT is the transmitral Doppler deceleration time. METHODS AND RESULTS: In 54 patients with chronic systolic heart failure (39 men, 15 women; age 65 +/- 10 years; New York Heart Association [NYHA], 2.3 +/- 0.9; ejection fraction [EF], 32% +/- 5%), we analyzed the relationship between K(LV) and an index of neurohormonal derangement (levels of brain natriuretic peptide [BNP]), and investigated whether 3 months of physical training could modulate diastolic operating stiffness. Patients were randomized to physical training (n = 27) or to a control group (n = 27). Before and after training, patients underwent Doppler echocardiogram and cardiopulmonary stress test. At baseline, ventricular stiffness was related to BNP levels (P < .01). Training improved NYHA class, exercise performance, and estimated pulmonary pressure. BNP was reduced. Ventricular volumes, mean blood pressure, and EF remained unchanged. A 27% reduction of elastance was observed (K(LV), 0.111 +/- 0.044 from 0.195 +/- 0.089 mm Hg/mL; P < .01), whose magnitude was related to changes in BNP (P < .05) and to K(LV) at baseline (P < .01). No changes in K(LV) were observed in controls after 3 months (0.192 +/- 0.115 from 0.195 +/- 0.121 mm Hg/mL). CONCLUSIONS: In heart failure, left ventricular diastolic stiffness is related to neurohormonal derangement and is modified by physical training. This improvement in LV compliance could result from a combination of hemodynamic improvement and regression of the fibrotic process. |
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Authors:
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Gabriella Malfatto; Giovanna Branzi; Giuseppe Osculati; Paola Valli; Paola Cuoccio; Francesca Ciambellotti; Gianfranco Parati; Mario Facchini |
Publication Detail:
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Type: Comparative Study; Journal Article; Randomized Controlled Trial Date: 2008-12-23 |
Journal Detail:
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Title: Journal of cardiac failure Volume: 15 ISSN: 1532-8414 ISO Abbreviation: J. Card. Fail. Publication Date: 2009 May |
Date Detail:
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Created Date: 2009-04-28 Completed Date: 2010-02-22 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9442138 Medline TA: J Card Fail Country: United States |
Other Details:
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Languages: eng Pagination: 327-33 Citation Subset: IM |
Affiliation:
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Divisione di Cardiologia, Ospedale San Luca, Istituto Auxologico Italiano Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milano, Italy. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Cardiomyopathy, Dilated / blood, physiopathology*, therapy* Diastole / physiology Exercise / physiology* Female Follow-Up Studies Heart Failure, Systolic / blood, physiopathology, therapy Humans Male Middle Aged Natriuretic Peptide, Brain / blood Ventricular Dysfunction, Left / blood, physiopathology*, therapy* |
| Chemical | |
Reg. No./Substance:
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114471-18-0/Natriuretic Peptide, Brain |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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