Isolated Left Ventricular Diastolic Dysfunction: Implications for Exercise Left Ventricular Performance in Patients Without Congestive Heart Failure

Palmieri, Vittorio; Russo, Cesare; Palmieri, Emiliano Antonio; Arezzi, Emma; Pezzullo, Salvatore; Minichiello, S.; Martino, Stefania; Migliaresi, Paola; Celentano, Aldo

doi:10.1016/j.echo.2005.12.011

Cited by 21 publications

(17 citation statements)

References 43 publications

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“…Diastolic function, as assessed by tissue Doppler imaging has also been shown to be predictive of exercise tolerance in patients with heart failure [23]. Additionally, the presence of diastolic dysfunction in patients without systolic dysfunction is a marker of impaired exercise tolerance [24]. Other studies have shown brief diastolic dysfunction following prolonged exhaustive exercise suggesting a varied response of diastolic function depending on the level of training and type of exercise.…”

Section: Discussionmentioning

confidence: 99%

Myocardial adaptation and efficiency in response to intensive physical training in elite speedskaters

Poh

Ton-Nu

Neilan

et al. 2008

International Journal of Cardiology

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Section: Discussionmentioning

confidence: 99%

Myocardial adaptation and efficiency in response to intensive physical training in elite speedskaters

Poh

Ton-Nu

Neilan

et al. 2008

International Journal of Cardiology

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“…The Physio Flow uses a high-frequency and low-amperage alternating electrical current via six electrodes. The Physio Flow has been found to be a valid and reliable estimate of cardiac output and stroke volume at rest and during moderate to high-intensity exercise in healthy normal weight (Charloux et al 2000;Palmieri et al 2006;Richard et al 2001;Tordi et al 2004;Welsman et al 2005), overweight (Richard et al 2001;Palmieri et al 2006), and obese (Palmieri et al 2006) participants. Richard et al (2001) evaluated the reproducibility and accuracy of the Physio Flow against the direct Fick method during an incremental exercise test from rest to maximal exercise in normal-weight and overweight participants.…”

Section: Cardiac Variables Measurementsmentioning

confidence: 99%

“…This difference was not influenced by an increase in intensity or cardiac output. Palmieri et al (2006) compared the Physio Flow to Echocardiographic Doppler during an incremental maximal stress test on a cycle ergometer in normal-weight, overweight, and obese adults and reported a mean difference of 3.0 ± 12.0 ml in stroke volume between methods, intraclass correlation coefficient of 0.71, a 95% confidence interval of 0.43-0.88, and a standardized reliability coefficient alpha of 0.82. Test-retest reproducibility was reported as an intraclass correlation coefficient for stroke volume (0.77) and cardiac output (0.56).…”

Section: Cardiac Variables Measurementsmentioning

confidence: 99%

Cardiac function and arteriovenous oxygen difference during exercise in obese adults

2010

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The purpose of this study was to assess cardiac function and arteriovenous oxygen difference (a-vO(2) difference) at rest and during exercise in young, normal-weight (n = 20), and obese (n = 12) men and women who were matched for age and fitness level. Participants were assessed for body composition, peak oxygen consumption (VO(2peak)), and cardiac variables (thoracic bioimpedance)-cardiac index (CI), cardiac output (Q), stroke volume (SV), heart rate (HR), and ejection fraction (EF)-at rest and during cycling exercise at 65% of VO(2peak). Differences between groups were assessed with multivariate ANOVA and mixed-model ANOVA with repeated measures controlling for sex. Absolute VO(2peak) and VO(2peak) relative to fat-free mass (FFM) were similar between normal-weight and obese groups (Mean ± SEE 2.7 ± 0.2 vs. 3.3 ± 0.3 l min(-1), p = 0.084 and 52.4 ± 1.5 vs. 50.9 ± 2.3 ml kg FFM(-1) min(-1), p = 0.583, respectively). In the obese group, resting Q and SV were higher (6.7 ± 0.4 vs. 4.9 ± 0.1 l min(-1), p < 0.001 and 86.8 ± 4.3 vs. 65.8 ± 1.9 ml min(-1), p < 0.001, respectively) and EF lower (56.4 ± 2.2 vs. 65.5 ± 2.2%, p = 0.003, respectively) when compared with the normal-weight group. During submaximal exercise, the obese group demonstrated higher mean CI (8.8 ± 0.3 vs. 7.7 ± 0.2 l min(-1) m(-2), p = 0.007, respectively), Q (19.2 ± 0.9 vs. 13.1 ± 0.3 l min(-1), p < 0.001, respectively), and SV (123.0 ± 5.6 vs. 88.9 ± 4.1 ml min(-1), p < 0.001, respectively) and a lower a-vO(2) difference (10.4 ± 1.0 vs. 14.0 ± 0.7 ml l00 ml(-1), p = 0.002, respectively) compared with controls. Our study suggests that the ability to extract oxygen during exercise may be impaired in obese individuals.

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“…7 On the other hand, LV diastolic dysfunction may be found in Ϸ26% of hypertensive subjects without LV hypertrophy and with normal myocardial contractility. 8 LV hypertrophy regression, proven to be protective in hypertension, 9 is a major determinant of LV diastolic dysfunction regression in hypertensive subjects. 7 However, it remains to be explored whether isolated LV diastolic dysfunction regression would impact independently on cardiovascular prevention in arterial hypertension.…”

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confidence: 99%

Treatment of Isolated Left Ventricular Diastolic Dysfunction in Hypertension

2010

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A rterial hypertension is a major risk factor for congestive heart failure. Left ventricular (LV) hypertrophy is often associated with arterial hypertension and characterizes subjects with a particularly elevated risk of untoward cardiovascular events, including heart failure. 1 LV hypertrophy is, in turn, associated with impaired LV myocardial contractility and LV diastolic dysfunction. LV hypertrophy, impaired LV myocardial contractility, and LV diastolic dysfunction predict heart failure in population-based studies. 2,3 Subjects with heart failure but with normal LV ejection fraction, that is, with diastolic heart failure, exhibit abnormal LV diastolic function. 4 However, Doppler parameters of LV diastolic function may be abnormal in the absence of overt heart failure. Such a condition, called "isolated LV diastolic dysfunction," bears independent prognostic significance in population-based and clinical studies. 2,3,5 Thus, regression of isolated LV diastolic dysfunction may be considered an important therapeutic target in hypertension.In the general adult population without congestive heart failure, Ϸ30% may show LV diastolic dysfunction of any degree. 6 In high-risk subgroups (patients Ͼ65 years of age, those with hypertension, and those with LV hypertrophy), the prevalence of isolated LV diastolic dysfunction rises to 60 -80%. 7 On the other hand, LV diastolic dysfunction may be found in Ϸ26% of hypertensive subjects without LV hypertrophy and with normal myocardial contractility. 8 LV hypertrophy regression, proven to be protective in hypertension, 9 is a major determinant of LV diastolic dysfunction regression in hypertensive subjects. 7 However, it remains to be explored whether isolated LV diastolic dysfunction regression would impact independently on cardiovascular prevention in arterial hypertension.In the present issue of Hypertension, Solomon et al 10 focused on isolated LV diastolic dysfunction regression in hypertension using a novel study design. The large majority of the participants in the study by Solomon et al 10 had impaired LV relaxation, which was more prevalent than LV hypertrophy. The study tested the hypothesis that lower in-treatment blood pressure (BP) target could result in greater LV diastolic dysfunction regression. Accordingly, Doppler parameters of LV diastolic function were compared between a regimen defined "intensive," because of a predefined systolic BP (SBP) target of Ͻ130 mm Hg, and a second regimen defined "standard," because of a prespecified SBP target of Ͻ140 mm Hg. Combinations of valsartan, either 160 or 320 mg, plus amlodipine, either 5 or 10 mg, were used; additional antihypertensive medications were added if needed to reach the BP targets. The main finding of the study was that changes in Doppler parameters of LV diastolic function were comparable, on average, between the 2 treatment arms. Hence, on the matter of the impact of aggressive or standard antihypertensive treatment on LV diastolic dysfunction regression, there is apparently no good news.However, the st...

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Isolated Left Ventricular Diastolic Dysfunction: Implications for Exercise Left Ventricular Performance in Patients Without Congestive Heart Failure

Cited by 21 publications

References 43 publications

Myocardial adaptation and efficiency in response to intensive physical training in elite speedskaters

Myocardial adaptation and efficiency in response to intensive physical training in elite speedskaters

Cardiac function and arteriovenous oxygen difference during exercise in obese adults

Treatment of Isolated Left Ventricular Diastolic Dysfunction in Hypertension

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