Role of left ventricular stiffness in heart failure with normal ejection fraction
Role of left ventricular stiffness in heart failure with normal ejection fraction
复制标题
DOI：
10.1161/circulationaha.107.716886
复制
发表时间：
2008-04-22
期刊：
影响因子：
37.8
通讯作者：
Tschoepe, Carsten
中科院分区：
文献类型：
--
作者：
Westermann, Dirk;Kasner, Mario;Tschoepe, Carsten
左心室僵硬度增加是射血分数正常的心力衰竭（HFNEF）患者的一个独特发现。为了阐明舒张功能障碍如何有助于心力衰竭运动过程中，我们进行了一项研究，使用侵入性压力-容积环的方法，并测量心脏功能在休息和心房起搏和手柄exercise.Methods和Results-Patients HFNEF（n=70）和患者没有心力衰竭症状（n=20）被招募。在基础状态、握力运动和心房起搏（120 bpm）下，用电导导管测量压力-容积环，以分析左心室舒张和收缩功能。在短暂的前负荷减少期间，直接测量舒张刚度常数。在基础状态下，HFNEF患者的舒张功能随着僵硬度的增加而显著受损。这是与增加舒张末期压力在握力运动和减少每搏输出量和心房pacing. Conclusions增加左心室僵硬度的压力-容积环的一个快速移动增加舒张末期压力在握力运动和减少每搏输出量在心房起搏HFNEF患者。这些数据表明，左心室僵硬度调节HFNEF患者的心脏功能，并表明舒张功能障碍伴僵硬度增加是治疗HFNEF的目标。
Background-Increased left ventricular stiffness is a distinct finding in patients who have heart failure with normal ejection fraction (HFNEF). To elucidate how diastolic dysfunction contributes to heart failure symptomatology during exercise, we conducted a study using an invasive pressure-volume loop approach and measured cardiac function at rest and during atrial pacing and handgrip exercise.Methods and Results-Patients with HFNEF (n=70) and patients without heart failure symptoms (n=20) were enrolled. Pressure-volume loops were measured with a conductance catheter during basal conditions, handgrip exercise, and atrial pacing with 120 bpm to analyze diastolic and systolic left ventricular function. During transient preload reduction, the diastolic stiffness constant was measured directly. Diastolic function with increased stiffness was significantly impaired in patients with HFNEF during basal conditions. This was associated with increased end-diastolic pressures during handgrip exercise and with decreased stroke volume and a leftward shift of pressure-volume loops during atrial pacing.Conclusions-Increased left ventricular stiffness contributed to increased end-diastolic pressure during handgrip exercise and decreased stroke volume during atrial pacing in patients with HFNEF. These data suggest that left ventricular stiffness modulates cardiac function in HFNEF patients and suggests that diastolic dysfunction with increased stiffness is a target for treating HFNEF.