Circulation. 2003;107:714-720
Published online before print January 20, 2003, doi: 10.1161/01.CIR.0000048123.22359.A0
Published online before print January 20, 2003, doi: 10.1161/01.CIR.0000048123.22359.A0
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(Circulation. 2003;107:714.)
© 2003 American Heart Association, Inc.
Clinical Investigation and Reports |
Combined Ventricular Systolic and Arterial Stiffening in Patients With Heart Failure and Preserved Ejection Fraction
Implications for Systolic and Diastolic Reserve Limitations
From the Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Md.
Correspondence to David A. Kass, MD, Halsted 500, Johns Hopkins Medical Institutions, 600 N Wolfe St, Baltimore, MD 21287. E-mail dkass{at}bme.jhu.edu
Background— Heart failure with preserved ejection fraction (HF-nlEF) is common in aged individuals with systolic hypertension and is frequently ascribed to diastolic dysfunction. We hypothesized that such patients also display combined ventricular-systolic and arterial stiffening that can exacerbate blood pressure lability and diastolic dysfunction under stress.
Methods and Results— Left ventricular pressure-volume relations were measured in patients with HF-nlEF (n=10) and contrasted with asymptomatic age-matched (n=9) and young (n=14) normotensives and age- and blood pressure-matched controls (n=25). End-systolic elastance (stiffness) was higher in patients with HF-nlEF (4.7±1.5 mm Hg/mL) than in controls (2.1±0.9 mm Hg/mL for normotensives and 3.3±1.0 mm Hg/mL for hypertensives; P<0.001). Effective arterial elastance was also higher (2.6±0.5 versus 1.9±0.5 mm Hg/mL) due to reduced total arterial compliance; the latter inversely correlated with end-systolic elastance (P=0.0001). Body size and stroke volumes were similar and could not explain differences in ventricular-arterial stiffening. HF-nlEF patients also displayed diastolic abnormalities, including higher left ventricular end-diastolic pressures (24.3±4.6 versus 12.9±5.5 mm Hg), caused by an upward-shifted diastolic pressure-volume curve. However, isovolumic relaxation and the early-to-late filling ratio were similar in age- and blood pressure-matched controls. Ventricular-arterial stiffening amplified stress-induced hypertension, which worsened diastolic function, and predicted higher cardiac energy costs to provide reserve output.
Conclusion— Patients with HF-lnEF have systolic-ventricular and arterial stiffening beyond that associated with aging and/or hypertension. This may play an important pathophysiological role by exacerbating systemic load interaction with diastolic function, augmenting blood pressure lability, and elevating cardiac metabolic demand under stress.
Key Words: heart failure • diastole • compliance • aging • hypertension
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