Lack of Diastolic Reserve in Patients With Heart Failure and Normal Ejection Fraction

Abstract

Background-The genesis of symptoms in patients with heart failure (HF) and normal ejection fraction (HFNEF) is unclear. Most investigations of HFNEF have focused on cardiac function at rest although most of these patients are breathless only on exercise. Stress-induced impairment in systolic or diastolic function could result in these symptoms. Method and Result-Forty-one patients with HFNEF and 29 controls underwent dobutamine stress echocardiography with color tissue Doppler imaging. Wall motion score index and regional myocardial systolic velocity (Sm) were measured at and peak stress. Systolic (Sa), early diastolic (Ea), and late diastolic (Aa) mitral annular velocities were averaged over the 6 periannular sites. Mitral annular long-axis velocity was lower in the HFNEF than controls at rest. Global, regional, and long-axis systolic function did not worsen with stress in the HFNEF group. The Ea decreased and the E/Ea increased with stress in the HFNEF but not in controls. The 6-minute walk distance was shorter and negatively correlated to the E/EA ratio at rest and stress in the HFNEF group. Conclusion-Impaired diastolic reserve results in stress-induced increase in the left ventricular end-diastolic pressure in patients with HFNEF giving rise to exercise intolerance. (Circ Heart Fail. 2010;3:35-43.)

Enhanced Pulmonary Vasodilator Reserve and Abnormal Right Ventricular

“…The current study enrolled subjects with an earlier stage of HFpEF, where filling pressures were closer to normal at rest and physical examination evidence of congestion was largely absent. Despite the absence of right-sided structural remodeling, RV systolic and diastolic function were significantly impaired in the HFpEF group, differences that became more evident in the setting of β-stimulation, similar to prior studies evaluating LV-systemic arterial reserve with adrenergic stimulation [9][10][11][12][13] or exercise stress. 36,37 In HFpEF subjects, tricuspid annular s′ increased with dobutamine in relation to afterload reduction from dobutamine rather than an increase in contractility, which would manifest by an upward shift in the s′ versus PA pressure relationship.…”

Cardiac Diastolic Function Is Impaired at Rest and Worsens With Exercise in Otherwise Healthy Individuals With Insulin Resistance

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New insights into weaning from mechanical ventilation: left ventricular diastolic dysfunction is a key player

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