Document Detail

Masked diastolic dysfunction caused by exercise testing in hypertensive heart failure patients with normal ejection fraction and normal or mildly increased LV mass.
MedLine Citation:
PMID:  20058507     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: It is not clear whether in patients with the clinical suspicion of heart failure with normal ejection fraction (HFNEF) exercise assessment of diastolic function may help to unmask abnormalities not detected by resting measurements. METHODS AND RESULTS: A combined radionuclide angiographic and haemodynamic exercise study was performed to confirm definite diastolic dysfunction in hypertensive patients with exertional dyspnoea and no other detectable cause of their symptoms. Only patients with normal baseline left ventricular (LV) systolic and diastolic function parameters as evaluated by routine cardiac catheterization and transmitral Doppler echocardiography were accepted (n = 38). All parameters were compared to a control group (n = 10). Twenty-eight patients showed an abnormal elevation in pulmonary capillary wedge pressure with exercise. As a consequence of a reduced exercise stroke volume (58 +/- 13 vs. 70 +/- 12 ml/m2; P = 0.01) peak cardiac output was reduced in HFNEF (9.3 +/- 1.7 vs. 7.6 +/- 2.0 l/min/m2; P = 0.02). These changes were equally demonstrable in patients with and without ventricular hypertrophy. LV end-systolic wall stress (ESWS) was increased at rest and during exercise in HFNEF patients without hypertrophy. However, a positive relationship between ESWS and the corresponding exercise stroke volume (r = 0.57; P = 0.002) was observed in the entire HFNEF group. CONCLUSION: Detection of diastolic dysfunction in suspected HFNEF is not only a question of the diagnostic methods used, but of the conditions under which the patients are investigated.
Gunnar Plehn; Julia Vormbrock; Martin Christ; Magnus Prull; Lutz Lefringhausen; Hans-Joachim Trappe; Axel Meissner
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Acta cardiologica     Volume:  64     ISSN:  0001-5385     ISO Abbreviation:  Acta Cardiol     Publication Date:  2009 Oct 
Date Detail:
Created Date:  2010-01-11     Completed Date:  2010-02-03     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370570     Medline TA:  Acta Cardiol     Country:  Belgium    
Other Details:
Languages:  eng     Pagination:  617-26     Citation Subset:  IM    
Department of Cardiology and Angiology, Marienhospital Herne, University of Bochum, Germany.
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MeSH Terms
Diagnosis, Differential
Echocardiography, Doppler
Exercise Test / methods*
Follow-Up Studies
Heart Failure, Diastolic / diagnosis,  etiology,  physiopathology*
Heart Ventricles / physiopathology*,  radionuclide imaging,  ultrasonography
Hypertension / complications*,  diagnosis,  physiopathology
Middle Aged
Myocardial Contraction / physiology*
Prospective Studies
Radionuclide Angiography
Severity of Illness Index
Stroke Volume / physiology*

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

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