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Systolic and diastolic function in patients with chronic heart failure at rest and during exercise
L Spinarova1, J Toman, M Stejfa
11st Department of Internal Medicine, Masaryk University, Brno, Czech Republic.
Insights
Diastolic function, not just systolic function, significantly impacts chronic heart failure (CHF) patients' capacity. Filling conditions and effective diastole duration are crucial for managing CHF.
Area of Science:
- Cardiology
- Cardiovascular Physiology
Background:
- Chronic heart failure (CHF) significantly impairs cardiac function.
- Systolic parameters like ejection fraction (EF) are commonly assessed, but diastolic function also plays a critical role.
Purpose of the Study:
- To evaluate systolic and diastolic function in CHF patients using echocardiography and invasive pulmonary capillary wedge pressure (PCWP).
- To assess the influence of filling conditions and diastolic function on functional capacity in CHF.
Main Methods:
- Simultaneous right heart catheterization and echocardiography were performed on 19 NYHA II-III CHF patients.
- Measurements included PCWP, blood gas exchange, and echocardiographic parameters (EF, E/A ratio, filling period) at rest and during exercise (handgrip, bicycle stress test).
- Patients were grouped based on median resting PCWP.
Main Results:
- Higher PCWP (Group B) correlated with significantly lower peak oxygen consumption (pVO2) compared to lower PCWP (Group A).
- No significant differences in end-diastolic volume (EDV), end-systolic volume (ESV), or EF between groups.
- Group B showed a restrictive filling pattern (E/A ratio > 1) and during bicycle exercise, a longer mitral regurgitation (MR) time and shorter filling period (FP) compared to Group A.
Conclusions:
- Functional capacity in CHF patients is influenced by diastolic filling conditions, not solely by systolic function (EF).
- The duration of effective left ventricular filling (diastole) is a critical factor in CHF functional capacity.
- Echocardiographic and invasive measures of diastolic function provide valuable insights into CHF severity and patient prognosis.
Abstract:
In our study we tried to evaluate systolic and diastolic function in patients with chronic heart failure (CHF) by using some echocardiographic parameters and invasively measured pulmonary capillary wedge pressure (PCWP). We studied 19 patients with CHF NYHA II-III at rest, at the end of isometric exercise (handgrip) and during a bicycle stress test. Right heart catheterization and echocardiography were simultaneously performed. We measured exchange of blood gases, end diastolic volume (EDV), end systolic volume (ESV), ejection fraction (EF), peak E velocity, peak A velocity, E/A ratio, deceleration time of E wave (DT), time of mitral regurgitation (MR) and effective filling period of left ventricle (FP). We divided patients according to the median of PCWP at rest into two groups: group A with PCWP< or =11 mmHg (10 pts), group B with PCWP>11 mmHg (9 pts). In group A mean PCWP at rest was 6+/-2 mmHg, during handgrip 12+/-4 mmHg and during bicycle exercise 18+/-6 mmHg. In group B mean values of PCWP were 19+/-6 mmHg, 26+/-11 mmHg and 33+/-5 mmHg, respectively. All values were significantly higher in group B (P<0.01). There was a significant difference in pVO2: in group A 18.8+/-3.5 vs. 14.7+/-3.3 ml/kg per min in group B (P<0.03). No differences between the groups were noticed in EDV, ESV and EF. The E/A ratio in group A was less than 1, in group B greater than 1 with the restrictive pattern. No differences between the groups were observed in MR and FP at rest. During bicycle exercise, MR was significantly longer (284+/-98 vs. 164+/-79 ms; P<0.05) and FP shorter (322+/-99 vs. 421+/-74 ms; P<0.05) in group B than in group A. The functional capacity of patients with CHF is influenced not only by EF and other systolic variables, but also by filling conditions. The duration of effective diastole may be one of the most important of them.