Abstract 3811: Moderate Exercise Results in a Major Increase of Proximal Arterial Stiffness in Diastolic Heart Failure
Background: Heart failure (HF) with preserved left ventricular ejection fraction (EF) is associated with ventriculo arterial stiffening.
Hypothesis: We assessed the hypothesis that proximal arterial stiffness is underestimated at rest in HF patients and unmasked by moderate exercise.
Method: We compared 23 patients with stable chronic HF, EF over 45%, impaired left ventricular relaxation, with 15 controls without cardiac disease. Patients were compared at rest and during a 30W exercise. The followings were measured or calculated using echography, Doppler and carotid tonometry: left ventricular end systolic elastance (Ees), peripheral resistance, arterial elastance (Ea), aortic pulse wave velocity and carotid Peterson modulus (Ep). Student T test or χ2 were used. Values were expressed as mean±1 standard deviation or percentage.
Results: Patients with HF were comparable with controls regarding age (66±10 vs 67±7), sex ratio, blood pressure, heart rate, Ees (1.9±0.7 vs 2.1±0.4 ml/mmHg), stroke and end diastolic volumes, peripheral resistance, Ea (1.7±0.6 vs 1.5±0.3 ml/mmHg), pulse wave velocity (12.0±4.7 vs 11.5±2.8 m/s). HF was associated with an increase of carotid stiffness (Ep: 1.96±1.36 vs 1.16±0.25 kPa102, p=0.01) and a lower EF (59±8 vs 67±12%, p<0.01)). Ventriculo arterial coupling was moderately impaired at rest by use of Ees/Ea and Ees/Ep ratio (p<0.01 for both). HF was associated during exercise with a major increase of Ep (+155±193 vs -5±28%), pulse wave velocity (+20±30 vs -7±24%), Ea (+12±15 vs -5±10%) and a lesser reducing in peripheral resistance (-17±12 vs -26±12%) compared with controls (p<0.05 for all). In addition, stroke volume (+10±16 vs +21±12%) increased lesser despite a higher increased in Ees (+20±18% vs +3±12%) compared with controls (p<0.05 for all). During exercise, Ees/Ep adaptation was impaired in HF patients (: -26±47 vs +20±47%, p<0.01) and modifications of Ees/Ea were similar.
Conclusion: In conclusion, diastolic HF is associated with a major increase of proximal arterial stiffness during exercise, leading to a dynamic unbalance of proximal ventriculo arterial coupling, while systolic function was preserved during exercise.