Characterization of static and dynamic left ventricular diastolic function in patients with heart failure with a preserved ejection fraction.

Anand Prasad, Jeffrey L Hastings, Shigeki Shibata, Zoran B. Popovic, Armin Arbab-Zadeh, Paul S. Bhella, Kazunobu Okazaki, Qi Fu, Martin Berk, Dean Palmer, Neil L. Greenberg, Mario J. Garcia, James D. Thomas, Benjamin D Levine

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Abstract

BACKGROUND: Congestive heart failure in the setting of a preserved left ventricular (LV) ejection fraction is increasing in prevalence among the senior population. The underlying pathophysiologic abnormalities in ventricular function and structure remain unclear for this disorder. We hypothesized that patients with heart failure with preserved ejection fraction (HFPEF) would have marked abnormalities in LV diastolic function with increased static diastolic stiffness and slowed myocardial relaxation compared with age-matched healthy controls. METHODS AND RESULTS: Eleven highly screened patients (4 men, 7 women) aged 73±7 years with HFPEF were recruited to participate in this study. Thirteen sedentary healthy controls (7 men, 6 women) aged 70±4 years also were recruited. All subjects underwent pulmonary artery catheterization with measurement of cardiac output, end-diastolic volumes, and pulmonary capillary wedge pressures at baseline; cardiac unloading (lower-body negative pressure or upright tilt); and cardiac loading (rapid saline infusion). The data were used to define the Frank-Starling and LV end-diastolic pressure-volume relationships. Doppler echocardiographic data (tissue Doppler velocities, isovolumic relaxation time, propagation velocity of early mitral inflow , E/A-wave ratio) were obtained at each level of cardiac preload. Compared with healthy controls, patients with HFPEF had similar LV contractile function and static LV compliance but reduced LV chamber distensibility with elevated filling pressures and slower myocardial relaxation as assessed by tissue Doppler imaging. CONCLUSIONS: In this small, highly screened patient population with hemodynamically confirmed HFPEF, increased end-diastolic static ventricular stiffness relative to age-matched controls was not a universal finding. Nevertheless, patients with HFPEF, even when well compensated, had elevated filling pressures, reduced distensibility, and increased diastolic wall stress compared with controls. In contrast, LV relaxation as assessed by tissue Doppler variables appeared consistently impaired in patients with HFPEF.

Original languageEnglish (US)
Pages (from-to)617-626
Number of pages10
JournalCirculation. Heart failure
Volume3
Issue number5
DOIs
StatePublished - Sep 1 2010

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Left Ventricular Function
Heart Failure
Stroke Volume
Swan-Ganz Catheterization
Lower Body Negative Pressure
Starlings
Pressure
Pulmonary Wedge Pressure
Ventricular Function
Cardiac Output
Population
Compliance
Blood Pressure

ASJC Scopus subject areas

  • Medicine(all)

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Characterization of static and dynamic left ventricular diastolic function in patients with heart failure with a preserved ejection fraction. / Prasad, Anand; Hastings, Jeffrey L; Shibata, Shigeki; Popovic, Zoran B.; Arbab-Zadeh, Armin; Bhella, Paul S.; Okazaki, Kazunobu; Fu, Qi; Berk, Martin; Palmer, Dean; Greenberg, Neil L.; Garcia, Mario J.; Thomas, James D.; Levine, Benjamin D.

In: Circulation. Heart failure, Vol. 3, No. 5, 01.09.2010, p. 617-626.

Research output: Contribution to journalArticle

Prasad, A, Hastings, JL, Shibata, S, Popovic, ZB, Arbab-Zadeh, A, Bhella, PS, Okazaki, K, Fu, Q, Berk, M, Palmer, D, Greenberg, NL, Garcia, MJ, Thomas, JD & Levine, BD 2010, 'Characterization of static and dynamic left ventricular diastolic function in patients with heart failure with a preserved ejection fraction.', Circulation. Heart failure, vol. 3, no. 5, pp. 617-626. https://doi.org/10.1161/CIRCHEARTFAILURE.109.867044
Prasad, Anand ; Hastings, Jeffrey L ; Shibata, Shigeki ; Popovic, Zoran B. ; Arbab-Zadeh, Armin ; Bhella, Paul S. ; Okazaki, Kazunobu ; Fu, Qi ; Berk, Martin ; Palmer, Dean ; Greenberg, Neil L. ; Garcia, Mario J. ; Thomas, James D. ; Levine, Benjamin D. / Characterization of static and dynamic left ventricular diastolic function in patients with heart failure with a preserved ejection fraction. In: Circulation. Heart failure. 2010 ; Vol. 3, No. 5. pp. 617-626.
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T1 - Characterization of static and dynamic left ventricular diastolic function in patients with heart failure with a preserved ejection fraction.

AU - Prasad, Anand

AU - Hastings, Jeffrey L

AU - Shibata, Shigeki

AU - Popovic, Zoran B.

AU - Arbab-Zadeh, Armin

AU - Bhella, Paul S.

AU - Okazaki, Kazunobu

AU - Fu, Qi

AU - Berk, Martin

AU - Palmer, Dean

AU - Greenberg, Neil L.

AU - Garcia, Mario J.

AU - Thomas, James D.

AU - Levine, Benjamin D

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Y1 - 2010/9/1

N2 - BACKGROUND: Congestive heart failure in the setting of a preserved left ventricular (LV) ejection fraction is increasing in prevalence among the senior population. The underlying pathophysiologic abnormalities in ventricular function and structure remain unclear for this disorder. We hypothesized that patients with heart failure with preserved ejection fraction (HFPEF) would have marked abnormalities in LV diastolic function with increased static diastolic stiffness and slowed myocardial relaxation compared with age-matched healthy controls. METHODS AND RESULTS: Eleven highly screened patients (4 men, 7 women) aged 73±7 years with HFPEF were recruited to participate in this study. Thirteen sedentary healthy controls (7 men, 6 women) aged 70±4 years also were recruited. All subjects underwent pulmonary artery catheterization with measurement of cardiac output, end-diastolic volumes, and pulmonary capillary wedge pressures at baseline; cardiac unloading (lower-body negative pressure or upright tilt); and cardiac loading (rapid saline infusion). The data were used to define the Frank-Starling and LV end-diastolic pressure-volume relationships. Doppler echocardiographic data (tissue Doppler velocities, isovolumic relaxation time, propagation velocity of early mitral inflow , E/A-wave ratio) were obtained at each level of cardiac preload. Compared with healthy controls, patients with HFPEF had similar LV contractile function and static LV compliance but reduced LV chamber distensibility with elevated filling pressures and slower myocardial relaxation as assessed by tissue Doppler imaging. CONCLUSIONS: In this small, highly screened patient population with hemodynamically confirmed HFPEF, increased end-diastolic static ventricular stiffness relative to age-matched controls was not a universal finding. Nevertheless, patients with HFPEF, even when well compensated, had elevated filling pressures, reduced distensibility, and increased diastolic wall stress compared with controls. In contrast, LV relaxation as assessed by tissue Doppler variables appeared consistently impaired in patients with HFPEF.

AB - BACKGROUND: Congestive heart failure in the setting of a preserved left ventricular (LV) ejection fraction is increasing in prevalence among the senior population. The underlying pathophysiologic abnormalities in ventricular function and structure remain unclear for this disorder. We hypothesized that patients with heart failure with preserved ejection fraction (HFPEF) would have marked abnormalities in LV diastolic function with increased static diastolic stiffness and slowed myocardial relaxation compared with age-matched healthy controls. METHODS AND RESULTS: Eleven highly screened patients (4 men, 7 women) aged 73±7 years with HFPEF were recruited to participate in this study. Thirteen sedentary healthy controls (7 men, 6 women) aged 70±4 years also were recruited. All subjects underwent pulmonary artery catheterization with measurement of cardiac output, end-diastolic volumes, and pulmonary capillary wedge pressures at baseline; cardiac unloading (lower-body negative pressure or upright tilt); and cardiac loading (rapid saline infusion). The data were used to define the Frank-Starling and LV end-diastolic pressure-volume relationships. Doppler echocardiographic data (tissue Doppler velocities, isovolumic relaxation time, propagation velocity of early mitral inflow , E/A-wave ratio) were obtained at each level of cardiac preload. Compared with healthy controls, patients with HFPEF had similar LV contractile function and static LV compliance but reduced LV chamber distensibility with elevated filling pressures and slower myocardial relaxation as assessed by tissue Doppler imaging. CONCLUSIONS: In this small, highly screened patient population with hemodynamically confirmed HFPEF, increased end-diastolic static ventricular stiffness relative to age-matched controls was not a universal finding. Nevertheless, patients with HFPEF, even when well compensated, had elevated filling pressures, reduced distensibility, and increased diastolic wall stress compared with controls. In contrast, LV relaxation as assessed by tissue Doppler variables appeared consistently impaired in patients with HFPEF.

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