Diastolic dysfunction in exercise and its role for exercise capacity

Abstract

Diastolic dysfunction is frequent in elderly subjects and in patients with left ventricular hypertrophy, vascular disease and diabetes mellitus. Patients with diastolic dysfunction demonstrate a reduced exercise capacity and might suffer from congestive heart failure (CHF). Presence of symptoms of CHF in the setting of a normal systolic function is referred to as heart failure with normal ejection fraction (HFNEF) or, if evidence of an impaired diastolic function is observed, as diastolic heart failure (DHF). Reduced exercise capacity in diastolic dysfunction results from a number of pathophysiological alterations such as slowed myocardial relaxation, reduced myocardial distensibility, elevated filling pressures, and reduced ventricular suction forces. These alterations limit the increase of ventricular diastolic filling and cardiac output during exercise and lead to pulmonary congestion. In healthy subjects, exercise training can enhance diastolic function and exercise capacity and prevent deterioration of diastolic function in the course of aging. In patients with diastolic dysfunction, exercise capacity can be enhanced by exercise training and pharmacological treatment, whereas improvement of diastolic function can only be observed in few patients.

Soccer Training Improves Cardiac Function in Men with Type 2 Diabetes

“…In STG, we observed significant improvements of exercise capacity in terms of increased V O 2max and intermittent endurance capacity, respectively, and these findings mirror results of a meta-analysis of beneficial effects of structured exercise interventions on cardiorespiratory fitness in T2DM patients (8). LV diastolic dysfunction can contribute to reduced exercise capacity, for example, by promoting a disproportionate increase in LV filling pressures during exercise, impaired myocardial perfusion, and reduced ability to increase stroke volume (7,22,33). Therefore, improved LV diastolic function in STG is likely to have significantly added to the increased exercise capacity observed in this group.…”

Increased Left Ventricular Stiffness Impairs Exercise Capacity in Patients with Heart Failure Symptoms Despite Normal Left Ventricular Ejection Fraction

“…Several pathophysiological mechanisms have been suggested to be involved in the development of the clinical scenario that limits physical performance in HFNEF patients [4]. They include an inadequate increase of ventricular diastolic filling and cardiac output during exercise, consequently leading to pulmonary congestion [5]. Echocardiographic studies have shown that, in HFNEF patients undergoing exercise, an increasing proportion of late diastolic filling can lead to a drop of the early proportion of diastolic filling.…”

Effects of long‐term endurance and resistance training on diastolic function, exercise capacity, and quality of life in asymptomatic diastolic dysfunction vs. heart failure with preserved ejection fraction

“…The prevalence of diastolic dysfunction (DD) is common in elderly subjects and in patients with left ventricular hypertrophy, arterial hypertension, valvular disease, coronary artery disease, and/or diabetes mellitus. For the diagnosis of DD, evidence of slow left ventricular relaxation, abnormal left ventricular filling, reduced diastolic distensibility, or increased left ventricular stiffness is required . Even in an asymptomatic stage, patients with DD are characterized by reduced exercise capacity and are at risk for the development of heart failure (HF) .…”