Abstract 3155: Is Diastolic Function Truly Abnormal in Heart Failure with a Preserved Ejection Fraction?
Background: Congestive heart failure (CHF) is the leading cause of hospitalizations in the elderly. Up to half of these patients have a preserved ejection fraction (HF-nlEF). Previous work in our lab has shown that healthy sedentary aging without CHF leads to increased left ventricular stiffness and a deterioration in Doppler measures of “diastolic function”. A comprehensive assessment of static and dynamic diastolic function has not been compared previously in HF-nlEF patients and age matched completely healthy controls.
Methods: 13 healthy but sedentary seniors (HEALTHY; 6 female, 7 male, 68 ± 3 years) and 11 seniors with HF-nlEF (unequivocal evidence of CHF; no valve disease, afib, or provokable ischemia; EF ≤ 50%) (7 female, 4 male, 74 ± 7 years) were enrolled. Subjects underwent measurement of
PCWP (right heart catheterization);
LVEDV (echocardiography); and
Doppler measures of mitral inflow patterns, IVRT, tissue Doppler imaging, and propagation velocity at 5 different levels of cardiac filling, above and below supine baseline values.
LV pressure-volume curves were modeled on an exponential equation.
Results: Mean baseline PCWP (15.2 ± 5.1 HF-nlEF vs. 11.4 ± 2.0 mmHg HEALTHY, p < 0.05) was higher in HF-nlEF , while baseline LVEDV index was slightly smaller (44.7 ± 8.2 HF-nlEF vs. 46.7 ± 11.1 ml/m2 HEALTHY), consistent with decreased distensibility. Static LV chamber stiffness was similar in both groups (stiffness constant: HF-nlEF 0.041 ± 0.038; HEALTHY 0.061 ± 0.030). E/A ratio was below 1.0 for both groups (0.78 ± 0.25 HF-nlEF vs. 0.83 ± 0.22 HEALTHY); Vp was less delayed (41.9 ± 12.7 HF-nlEF vs. 34.4 ± 7.4 cm/s HEALTHY), and IVRT was less prolonged (107 ± 29 HF-nlEF vs. 146 ± 20 ms HEALTHY, p < 0.05) in HF-nlEF likely due to higher LA and LV pressures. TDI relaxation velocities were slower in the HF-nlEF group: TDI E’mean (7.6 ± 1.5 HF-nlEF vs. 9.8 ± 1.8 cm/s HEALTHY, p < 0.05), consistent with slower relaxation.
Conclusions: HF-nlEF patients have increased dynamic but similar static chamber stiffness compared to sedentary but healthy controls. This increased stiffness is compounded by slowed relaxation which may lead to very high filling pressures and clinical heart failure under conditions of increased heart rate such as exercise or atrial fibrillation.