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Cardiac structure and ventricular-vascular function in persons with heart failure and preserved ejection fraction
Carolyn S P Lam1, Véronique L Roger, Richard J Rodeheffer
1Division of Cardiovascular Diseases, Mayo Clinic and Foundation, 200 First St SW, Rochester, MN 55905, USA.
Circulation
|April 4, 2007
Summary
Heart failure with normal ejection fraction (HFnlEF) is linked to impaired diastolic function and increased stiffness. Diastolic dysfunction progression is key in hypertensive heart disease, impacting HFnlEF development.
Area of Science:
- Cardiology
- Physiology
Background:
- Heart failure with normal ejection fraction (HFnlEF) pathophysiology involves diastolic dysfunction, stiffening, and volume expansion.
- Noninvasive characterization of cardiac mechanics in HFnlEF is crucial for understanding disease progression.
Purpose of the Study:
- To characterize left ventricular volume, arterial elastance, and ventricular elastance and relaxation noninvasively in HFnlEF patients and controls.
- To investigate the role of diastolic dysfunction in the development of HFnlEF.
Main Methods:
- Prospective enrollment of individuals without cardiovascular disease, with hypertension, and with HFnlEF.
- Utilized echo Doppler for end-diastolic volume, blood pressure, stroke volume, and ejection fraction to determine elastance parameters.
- Tissue Doppler and diastolic curve fitting (alpha and beta constants) were used to assess relaxation and stiffness.
Main Results:
- HFnlEF patients exhibited smaller end-diastolic volume index and cardiac output, with increased end-diastolic pressure compared to controls.
- Arterial and ventricular end-systolic elastance were elevated in hypertensive controls and HFnlEF patients versus healthy controls.
- HFnlEF patients demonstrated more impaired relaxation and increased diastolic stiffness than both control groups.
Conclusions:
- Progression of diastolic dysfunction is a significant factor in HFnlEF development, particularly in hypertensive heart disease.
- Noninvasive assessment reveals distinct mechanical abnormalities in HFnlEF, emphasizing diastolic dysfunction.
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