Document Detail

Restrictive left ventricular filling patterns are predictive of diastolic ventricular interaction in chronic heart failure.
MedLine Citation:
PMID:  9462587     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: The purpose of this study was to determine whether restrictive left ventricular (LV) filling patterns are associated with diastolic ventricular interaction in patients with chronic heart failure. BACKGROUND: We recently demonstrated a diastolic ventricular interaction in approximately 50% of a series of patients with chronic heart failure, as evidenced by paradoxic increases in LV end-diastolic volume despite reductions in right ventricular end-diastolic volume during volume unloading achieved by lower body negative pressure (LBNP). We reasoned that such an interaction would impede LV filling in mid and late diastole, but would be minimal in early diastole, resulting in a restrictive LV filling pattern. METHODS: Transmitral flow was assessed using pulsed wave Doppler echocardiography in 30 patients with chronic heart failure and an LV ejection fraction < or = 35%. Peak early (E) and atrial (A) filling velocities and E wave deceleration time were measured. Left ventricular end-diastolic volume was measured using radionuclide ventriculography before and during -30-mm Hg LBNP. RESULTS: Nine of the 11 patients with and 2 of the 16 patients without restrictive LV filling patterns (E/A > 2 or E/A 1 to 2 and E wave deceleration time < or = 140 ms) increased LV end-diastolic volume during LBNP (p = 0.001). The change in LV end-diastolic volume during LBNP was correlated with the baseline A wave velocity (r = -0.52, p = 0.005) and E/A ratio (r = 0.50, p = 0.01). CONCLUSIONS: Restrictive LV filling patterns are associated with diastolic ventricular interaction in patients with chronic heart failure. Volume unloading in the setting of diastolic ventricular interaction allows for increased LV filling. Identifying patients with chronic heart failure and restrictive filling patterns may therefore indicate a group likely to benefit from additional vasodilator therapy.
J J Atherton; T D Moore; H L Thomson; M P Frenneaux
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  31     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  1998 Feb 
Date Detail:
Created Date:  1998-02-26     Completed Date:  1998-02-26     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  413-8     Citation Subset:  AIM; IM    
Department of Cardiology, University of Wales College of Medicine, Cardiff, United Kingdom.
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MeSH Terms
Atrial Function, Left / physiology
Atrial Function, Right / physiology
Blood Flow Velocity / physiology
Blood Pressure / physiology
Cardiac Output / physiology*
Cardiac Volume / physiology
Echocardiography, Doppler, Pulsed
Gated Blood-Pool Imaging
Heart Failure / physiopathology*
Lower Body Negative Pressure
Middle Aged
Mitral Valve / physiopathology
Radiopharmaceuticals / diagnostic use
Sodium Pertechnetate Tc 99m / diagnostic use
Stroke Volume / physiology
Vasodilator Agents / therapeutic use
Ventricular Dysfunction, Left / physiopathology*
Ventricular Function, Right / physiology
Ventricular Pressure / physiology
Reg. No./Substance:
0/Radiopharmaceuticals; 0/Vasodilator Agents; 23288-60-0/Sodium Pertechnetate Tc 99m
Erratum In:
J Am Coll Cardiol 1998 Mar 1;31(3):744

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

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