Article thumbnail

Increased Left Ventricular Stiffness Impairs Exercise Capacity in Patients with Heart Failure Symptoms Despite Normal Left Ventricular Ejection Fraction

By David Sinning, Mario Kasner, Dirk Westermann, Karsten Schulze, Heinz-Peter Schultheiss and Carsten Tschöpe

Abstract

Aims. Several mechanisms can be involved in the development of exercise intolerance in patients with heart failure despite normal left ventricular ejection fraction (HFNEF) and may include impairment of left ventricular (LV) stiffness. We therefore investigated the influence of LV stiffness, determined by pressure-volume loop analysis obtained by conductance catheterization, on exercise capacity in HFNEF. Methods and Results. 27 HFNEF patients who showed LV diastolic dysfunction in pressure-volume (PV) loop analysis performed symptom-limited cardiopulmonary exercise testing (CPET) and were compared with 12 patients who did not show diastolic dysfunction in PV loop analysis. HFNEF patients revealed a lower peak performance (P = .046), breathing reserve (P = .006), and ventilation equivalent for carbon dioxide production at rest (P = .002). LV stiffness correlated with peak oxygen uptake (r = −0.636, P < .001), peak oxygen uptake at ventilatory threshold (r = −0.500, P = .009), and ventilation equivalent for carbon dioxide production at ventilatory threshold (r = 0.529, P = .005). Conclusions. CPET parameters such as peak oxygen uptake, peak oxygen uptake at ventilatory threshold, and ventilation equivalent for carbon dioxide production at ventilatory threshold correlate with LV stiffness. Increased LV stiffness impairs exercise capacity in HFNEF

Topics: Clinical Study
Publisher: SAGE-Hindawi Access to Research
OAI identifier: oai:pubmedcentral.nih.gov:3051202
Provided by: PubMed Central

To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.

Suggested articles

Citations

  1. (2006). A b h a y a r a t n a ,T .H .M a r w i c k ,W .T .S m i t h ,a n dN .G . Becker, “Characteristics of left ventricular diastolic dysfunction in the community: an echocardiographic survey,”
  2. (1997). ACC/AHA guidelines for exercise testing: a report of the American College of Cardiology/American Heart Association task force on practice guidelines (committee on exercise testing),”
  3. (2009). cCully ,G.C.Kane,C.Lam,andP .A.P ellikka, “Left ventricular function and exercise capacity,”
  4. (1984). Continuous measurement of left ventricular volume in animals and humans by conductance catheter,”
  5. (1993). Contribution of left ventricular diastolic function to exercise capacityinnormalsubjects,”JournalofAppliedPhysiology,vol.
  6. (2009). Diastolic dysfunction in exercise and its role for exercise capacity,” Heart Failure Reviews,
  7. (2006). Diastolic heart failure—a common and lethal condition by any name,”
  8. (2004). Diastolic heart failure—abnormalities in active relaxation and passive stiffnessoftheleftventricle,”NewEnglandJournalofMedicine,
  9. (1977). Echocardiographic determination of left ventricular mass in man.
  10. (1999). Exercise capacity in hypertrophic cardiomyopathy depends on left ventricular
  11. (2007). Exercise capacity, breathing pattern, and gas exchange during exercise for patients with isolated diastolic dysfunction,”
  12. (2009). Heart failure with preserved ejection fraction is characterized by dynamic impairment of active relaxation and contraction of the left ventricle on exercise and associated with myocardial energy deficiency,”
  13. (2007). How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography AssociationsoftheEuropeanSocietyofCardiology,”
  14. (2001). Hypertonic saline method accurately determines parallel conductance for dual-field conductance catheter,”
  15. (2001). Impact of myocardial diastolic dysfunction on coronary flow reserve in hypertensive patients with left ventricular hypertrophy,”
  16. (2004). Inspiratory muscle weakness in diastolic dysfunction,”
  17. (1989). l e x o p o u l o s ,J .M a c h a c ,R .R .A r o r a ,a n dS .F .H o r o w i t z , “Exercise-induced pulmonary blood volume changes and diastolic dysfunction of the aged heart,”
  18. (2010). M.Penicka,J.Bartunek,H.Trakalovaetal.,“Heartfailurewith preserved ejection fraction in outpatients with unexplained dyspnea—a pressure-volume loop analysis,”
  19. (1966). Myocardial structure and function differ in systolic and diastolic heart failure,”
  20. (2003). Normalization for peak oxygen uptake increases the prognostic power of the ventilatory response to exercise in patients with chronic heart failure,”
  21. (2006). O w a n ,D .O .H o d g e ,R .M .H e r g e s ,S .J .J a c o b s e n
  22. (2002). Pathophysiological characterization of isolated diastolic heart failure in comparison to systolic heart failure,”
  23. (2004). Peak VO and VE/VCO slope in patients with heart failure: a prognostic comparison,”
  24. (2005). Pellikka et al., “Diastolic stress echocardiography: a novel noninvasive diagnostic test for diastolic dysfunction using supine bicycle exercise Doppler echocardiography,”
  25. (2008). Role of left ventricular stiffness in heart failure with normal ejection fraction,”
  26. (2009). The pathophysiology of heart failure with normal ejection fraction: exercise echocardiography reveals complex abnormalities of both systolic and diastolic ventricular function involving torsion, untwist, and longitudinal motion,”
  27. (2005). The role of NT-proBNP in the diagnostics of isolated diastolic dysfunction: correlation with echocardiographic and invasive measurements,”
  28. (2007). Utility of Doppler echocardiography and tissue Doppler imaging in the estimation of diastolic function in heart failure with normalejection fraction:acomparative Doppler-conductance catheterization study,”