Published Online
on September 15, 2008

A more recent version of this article appeared on September 30, 2008

This Article Full Text (PDF) CME: Take the course for this article: Circulation: September 30, 2008, Volume 118, Number 14 All Versions of this Article: 118/14/1433    most recent CIRCULATIONAHA.108.783910v1 Alert me when this article is cited Alert me if a correction is posted 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 Zile, M. R. Articles by Bourge, R. C. Search for Related Content PubMed PubMed Citation Articles by Zile, M. R. Articles by Bourge, R. C. Related Collections Congestive Pathophysiology Echocardiography Related Article

Submitted on January 22, 2008
Accepted on July 10, 2008

Transition From Chronic Compensated to Acute Decompensated Heart Failure. Pathophysiological Insights Obtained From Continuous Monitoring of Intracardiac Pressures

Michael R. Zile MD^*, Tom D. Bennett PhD, Martin St. John Sutton MD, Yong K. Cho PhD, Philip B. Adamson MD, Mark F. Aaron MD, Juan M. Aranda Jr MD, William T. Abraham MD, Frank W. Smart MD, Lynne Warner Stevenson MD, Fred J. Kueffer MS, MD, and Robert C. Bourge MD

From the Medical University of South Carolina and RHJ Department of Veterans Affairs Medical Center, Charleston (M.R.Z.); Medtronic, Inc, Minneapolis, Minn (T.D.B., Y.K.C., F.J.K.); University of Pennsylvania, Philadelphia (M.S.J.S.); University of Oklahoma Health Sciences Center, Oklahoma City (P.B.A.); St Thomas Hospital, Nashville, Tenn (M.F.A.); University of Florida, Gainesville (J.M.A.); Ohio State University, Columbus (W.T.A.); Texas Heart Institute, Houston (F.W.S.); Brigham and Woman's Hospital, Harvard University, Boston, Mass (L.W.-S.); and University of Alabama at Birmingham (R.C.B.).

^* To whom correspondence should be addressed. E-mail: zilem{at}musc.edu.

Background—Approximately half of all patients with chronic heart failure (HF) have a decreased ejection fraction (EF) (systolic HF [SHF]); the other half have HF with a normal EF (diastolic HF [DHF]). However, the underlying pathophysiological differences between DHF and SHF patients are incompletely defined. The purpose of this study was to use echocardiographic and implantable hemodynamic monitor data to examine the pathophysiology of chronic compensated and acute decompensated HF in SHF versus DHF patients.

Methods and Results—Patients were divided into 2 subgroups: 204 had EF <50% (SHF) and 70 had EF 50% (DHF). DHF patients had EF of 58±8%, end-diastolic dimension of 50±10 mm, estimated resting pulmonary artery diastolic pressure (ePAD) of 16±9 mm Hg, and diastolic distensibility index (ratio of ePAD to end-diastolic volume) of 0.11±0.06 mm Hg/mL. In contrast, SHF patients had EF of 24±10%, end-diastolic dimension of 68±11 mm, ePAD of 18±7 mm Hg, and diastolic distensibility index of 0.06±0.04 mm Hg/mL (P<0.05 versus DHF for all variables except ePAD). In SHF and DHF patients who developed acute decompensated HF, these events were associated with a significant increase in ePAD, from 17±7 to 22±7 mm Hg (P<0.05) in DHF and from 21±9 to 24±8 mm Hg (P<0.05) in SHF. As a group, patients who did not have acute decompensated HF events had no significant changes in ePAD.

Conclusions—Significant structural and functional differences were found between patients with SHF and those with DHF; however, elevated diastolic pressures play a pivotal role in the underlying pathophysiology of chronic compensated and acute decompensated HF in both SHF and DHF.

Key words: diastole • heart failure • hemodynamics • physiology • systole

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Clinical Summaries
Circulation 2008 118: 1403-1404. [Extract] [Full Text]

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