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Pathophysiological rationale and diagnostic targets for diastolic stress testing.
Tamás Erdei1, Svend Aakhus2, Paolo Marino3
1Wales Heart Research Institute, Cardiff University, Cardiff, UK.
Heart (British Cardiac Society)
|May 24, 2015
Summary
Diastolic dysfunction, not systolic, better predicts heart function reserve. In older adults, lifelong exercise preserves diastolic function, aiding diagnosis of heart failure with preserved ejection fraction (HFpEF).
Area of Science:
- Cardiology
- Physiology
Background:
- Peak oxygen uptake reflects cardiopulmonary functional reserve.
- Cardiac diastolic function, rather than systolic function, better predicts this reserve at rest.
- Aging typically impairs diastolic relaxation and increases stiffness, but lifelong exercise can preserve these functions.
Purpose of the Study:
- To investigate the role of diastolic function in predicting cardiopulmonary reserve.
- To explore how aging and exercise affect diastolic function.
- To propose a diagnostic strategy for heart failure with preserved ejection fraction (HFpEF) using stress testing of diastolic function in elderly patients.
Main Methods:
- Assessment of cardiac diastolic function at rest and during exercise.
- Evaluation of mechanisms impairing diastolic filling and pressures, including reduced early diastolic recoil, increased preload, and reduced compliance.
- Consideration of ventricular-arterial coupling and ventricular interaction.
- Invasive studies measuring pulmonary capillary wedge pressure.
- Proposal for a systematic non-invasive diagnostic strategy.
Main Results:
- Diastolic function measures predict peak oxygen uptake better than systolic measures.
- Normal cardiac adaptations to training include resting bradycardia and increased LV end-diastolic volume.
- Lifelong exercise can preserve diastolic function in older adults.
- Impaired diastolic filling during exercise can result from reduced recoil, increased preload, and decreased compliance.
- Increased LV filling pressure and left atrial pressure are common pathways to breathlessness.
Conclusions:
- Diastolic dysfunction is a key factor in reduced cardiopulmonary reserve, particularly in aging.
- A comprehensive, non-invasive diagnostic approach assessing various aspects of inducible diastolic dysfunction is needed for HFpEF diagnosis.
- Targeted assessment of diastolic function during stress can improve diagnosis and treatment of HFpEF.
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