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Exercise hemodynamics in patients with and without diastolic dysfunction and preserved ejection fraction after

Mads J Andersen1, Mads Ersbøll, John Bro-Jeppesen

  • 1Department of Cardiology, the Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. madsand@dadlnet.dk

Circulation. Heart Failure
|June 19, 2012
PubMed

Insights

Patients with post-myocardial infarction (MI) diastolic dysfunction (DD) maintain cardiac output during exercise by increasing filling pressures. This diastolic dysfunction may accelerate heart failure progression after MI.

Area of Science:

  • Cardiology
  • Cardiovascular Physiology
  • Heart Failure Research

Background:

  • Left ventricular diastolic dysfunction (DD) is prevalent after myocardial infarction (MI), even with preserved ejection fraction.
  • The impact of DD on cardiac hemodynamics under stress post-MI remains incompletely understood.

Purpose of the Study:

  • To investigate the hemodynamic response to exercise in patients with recent MI and preserved ejection fraction, differentiating between those with and without diastolic dysfunction.
  • To determine if diastolic dysfunction influences cardiac filling pressures during stress.

Main Methods:

  • Invasive hemodynamic exercise testing using right heart catheterization and echocardiography in 46 MI patients (35 with DD, 11 without) and 10 healthy controls.
  • Patients were categorized based on left atrial volume index and diastolic E/e' ratio to define DD.
  • Exercise involved a supine cycle ergometer test.

Main Results:

  • At rest, 29% of MI patients with DD showed elevated pulmonary capillary wedge pressure (PCWP) compared to none in the MI-DD or control groups.
  • During exercise, 94% of MI+DD patients exhibited abnormal PCWP elevation, significantly higher than MI-DD patients (36%) and controls (0%).
  • Exercise right atrial pressure was highest in MI+DD, followed by MI-DD and controls, while cardiac index remained similar across groups.

Conclusions:

  • Post-MI patients with preserved ejection fraction and DD maintain exercise cardiac output by significantly increasing cardiac filling pressures.
  • Diastolic dysfunction and loss of diastolic reserve post-MI may contribute to the progression from Stage B to Stage C heart failure.
Abstract

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