This Article Full Text Full Text (PDF) All Versions of this Article: 117/12/1550    most recent CIRCULATIONAHA.107.730564v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Masutani, S. Articles by Cheng, C.-P. Search for Related Content PubMed PubMed Citation Articles by Masutani, S. Articles by Cheng, C.-P. Pubmed/NCBI databases Medline Plus Health Information Heart Failure Related Collections Heart failure - basic studies Related Article

(Circulation. 2008;117:1550-1554.)
© 2008 American Heart Association, Inc.

Heart Failure

Restrictive Left Ventricular Filling Pattern Does Not Result From Increased Left Atrial Pressure Alone

Satoshi Masutani, MD; William C. Little, MD; Hiroshi Hasegawa, MD, PhD; Heng-Jie Cheng, MD, PhD; Che-Ping Cheng, MD, PhD

From the Section on Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC.

Correspondence to William C. Little, MD, Cardiology Section, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157-1045. E-mail wlittle{at}wfubmc.edu

Received July 26, 2007; accepted January 29, 2008.

Background— The restrictive filling pattern seen with severe heart failure (HF) may be due to diastolic dysfunction with elevated left ventricular (LV) diastolic pressure or may be merely a manifestation of an overfilled LV as a result of increased left atrial (LA) pressure. We investigated whether the LV restrictive filling pattern is due to elevated LA pressure alone.

Methods and Results— We studied conscious dogs instrumented to measure LA pressure, LV pressure, and 3 LV diameters. LV filling dynamics were evaluated in 2 situations with similar elevations of LA pressure: in normal animals after rapid volume loading with dextran 500 mL and in animals with pacing-induced HF with restrictive filling. With HF, there was increased LV chamber stiffness and slow relaxation. Volume loading and HF had similar heart rates (129±19 versus 131±15 bpm) and LA pressure (22.1±5.8 versus 22.6±3.3 mm Hg). The peak early filling rate (E) was increased with both HF and volume loading. However, in HF, the peak mitral annular velocity (E') was decreased and delayed, and the E deceleration time was shorter. In contrast, with volume loading, E' was increased and not delayed.

Conclusion— The restrictive filling pattern is distinguished from overfilling of a normal ventricle by a reduced and delayed E' and a shortened E deceleration time that reflect slow relaxation and increased LV stiffness.

---

 

CLINICAL PERSPECTIVE

Related Article:

Clinical Summaries
Circulation 2008 117: 1499. [Extract] [Full Text]

This article has been cited by other articles:

				W. C. Little and J. K. Oh Echocardiographic Evaluation of Diastolic Function Can Be Used to Guide Clinical Care Circulation, September 1, 2009; 120(9): 802 - 809. [Full Text] [PDF]

				Y. Notomi and J. D. Thomas Presto Untwisting and Legato Filling J. Am. Coll. Cardiol. Img., June 1, 2009; 2(6): 717 - 719. [Full Text] [PDF]

				A. E. Weyman The year in echocardiography. J. Am. Coll. Cardiol., April 28, 2009; 53(17): 1558 - 1567. [Full Text] [PDF]

				R. Razzolini and G. Tarantini Letter by Razzolini and Tarantini Regarding Article, "Restrictive Left Ventricular Filling Pattern Does Not Result From Increased Left Atrial Pressure Alone" Circulation, September 23, 2008; 118(13): e505 - e505. [Full Text] [PDF]

				S. Masutani, W. C. Little, H. Hasegawa, H.-J. Cheng, and C.-P. Cheng Response to Letter Regarding Article, "Restrictive Left Ventricular Filling Pattern Does Not Result From Increased Left Atrial Pressure Alone" Circulation, September 23, 2008; 118(13): e506 - e506. [Full Text] [PDF]