Document Detail

Myocardial structure and function differ in systolic and diastolic heart failure.
MedLine Citation:
PMID:  16618817     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: To support the clinical distinction between systolic heart failure (SHF) and diastolic heart failure (DHF), left ventricular (LV) myocardial structure and function were compared in LV endomyocardial biopsy samples of patients with systolic and diastolic heart failure. METHODS AND RESULTS: Patients hospitalized for worsening heart failure were classified as having SHF (n=22; LV ejection fraction (EF) 34+/-2%) or DHF (n=22; LVEF 62+/-2%). No patient had coronary artery disease or biopsy evidence of infiltrative or inflammatory myocardial disease. More DHF patients had a history of arterial hypertension and were obese. Biopsy samples were analyzed with histomorphometry and electron microscopy. Single cardiomyocytes were isolated from the samples, stretched to a sarcomere length of 2.2 microm to measure passive force (Fpassive), and activated with calcium-containing solutions to measure total force. Cardiomyocyte diameter was higher in DHF (20.3+/-0.6 versus 15.1+/-0.4 microm, P<0.001), but collagen volume fraction was equally elevated. Myofibrillar density was lower in SHF (36+/-2% versus 46+/-2%, P<0.001). Cardiomyocytes of DHF patients had higher Fpassive (7.1+/-0.6 versus 5.3+/-0.3 kN/m2; P<0.01), but their total force was comparable. After administration of protein kinase A to the cardiomyocytes, the drop in Fpassive was larger (P<0.01) in DHF than in SHF. CONCLUSIONS: LV myocardial structure and function differ in SHF and DHF because of distinct cardiomyocyte abnormalities. These findings support the clinical separation of heart failure patients into SHF and DHF phenotypes.
Loek van Heerebeek; Attila Borbély; Hans W M Niessen; Jean G F Bronzwaer; Jolanda van der Velden; Ger J M Stienen; Wolfgang A Linke; Gerrit J Laarman; Walter J Paulus
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Publication Detail:
Type:  Journal Article     Date:  2006-04-17
Journal Detail:
Title:  Circulation     Volume:  113     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2006 Apr 
Date Detail:
Created Date:  2006-04-25     Completed Date:  2006-05-04     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1966-73     Citation Subset:  AIM; IM    
Department of Physiology, Institute for Cardiovascular Research, VU Medical Center, Amsterdam, The Netherlands.
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MeSH Terms
Cardiomegaly / pathology
Diastole / physiology*
Heart Failure / pathology*,  physiopathology
Heart Ventricles / pathology*
Middle Aged
Myocytes, Cardiac / pathology,  physiology
Systole / physiology*
Comment In:
Circulation. 2006 Apr 25;113(16):1922-5   [PMID:  16636184 ]

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