scholarly journals Diastolic dysfunction and natriuretic peptides in systolic heart failure. Higher ANP and BNP levels are associated with the restrictive filling pattern

1996 ◽  
Vol 17 (11) ◽  
pp. 1694-1702 ◽  
Author(s):  
C. M. Yu ◽  
J. E. Sanderson ◽  
I. O. L. Shum ◽  
S. Chan ◽  
L. Y. C. Yeung ◽  
...  
Keyword(s):  
Heart Failure ◽  
Diastolic Dysfunction ◽  
Natriuretic Peptides ◽  
Systolic Heart Failure ◽  
Filling Pattern

Diastolic dysfunction and abnormal exercise ventilation predict adverse outcome in elderly patients with chronic systolic heart failure

2011 ◽  
Vol 19 (3) ◽  
pp. 396-403 ◽  
Author(s):  
Gabriella Malfatto ◽  
Giovanna Branzi ◽  
Alessia Giglio ◽  
Francesca Ciambellotti ◽  
Alessandra Villani ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mitral Regurgitation ◽  
Ejection Fraction ◽  
Elderly Patients ◽  
Diastolic Dysfunction ◽  
Systolic Heart Failure ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Functional Mitral Regurgitation ◽  
Filling Pattern

Background: Heart failure is increasing in the elderly and represents a socioeconomic burden requiring the correct management for which risk stratification is mandatory. Among younger patients, echocardiogram and cardiopulmonary exercise test are useful in prognostic stratification. Few studies have analyzed the utility of these tests in elderly patients. Methods: We report on 90 patients over 70 years old, on whom cardiopulmonary tests and echocardiograms were performed between 1998 and 2006 (67 M, 23 F; 75 ± 3 years; ejection fraction (EF) 30 ± 6%; NYHA 2.1 ± 0.8; 60% ischemic; therapy according to international guidelines). Echocardiographic variables were (1) left ventricular ejection fraction (EF); (2) severity of diastolic dysfunction on multiparametric examination of Doppler and TDI parameters; (3) severity of functional mitral regurgitation. Cardiopulmonary variables were (1) peak VO2; (2) peak O2 pulse; (3) peak respiratory quotient (RQ); (4) VE/VCO2 slope. Endpoint considered was mortality of any cause at three-years follow-up. Results: Mortality was 21%. At univariate analysis, survivors ( n = 71) and deceased ( n = 19) were similar for age, NYHA class, peakVO2 and RQ; they differed for EF, severity of mitral regurgitation, severity of diastolic dysfunction, O2 pulse and VE/VCO2 slope. At multivariate analysis, only VE/VCO2 slope and severe diastolic dysfunction (restrictive filling pattern) discriminated between the two groups. In particular, the association of restrictive filling pattern and VE/VCO2 slope ≥ 45 predicted 3-year mortality with sensitivity of 84% and specificity of 88%. Conclusions: Echocardiographic and cardiopulmonary data can identify high-risk elderly patients with systolic heart failure, who may need aggressive clinical management.

scholarly journals Increase in plasma adrenomedullin in patients with heart failure characterised by diastolic dysfunction

Heart ◽  
2001 ◽  
Vol 86 (2) ◽  
pp. 155-160
Author(s):  
C-M Yu ◽  
B M Y Cheung ◽  
R Leung ◽  
Q Wang ◽  
W-H Lai ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Diastolic Dysfunction ◽  
Diastolic Heart Failure ◽  
Systolic Heart Failure ◽  
Left Ventricular ◽  
University Teaching ◽  
Patients With Heart Failure ◽  
Filling Pattern ◽  
Pattern Group

OBJECTIVETo investigate the relation between plasma adrenomedullin and the severity of diastolic dysfunction in patients with heart failure.DESIGNProspective study.SETTINGUniversity teaching hospital.PATIENTS77 patients (mean (SEM) age 66.3 (1.2) years; 75% male) who were being followed in the outpatient clinic after admission to hospital for acute heart failure.INTERVENTIONSSame day echocardiography with Doppler studies; determination of venous adrenomedullin concentration by radioimmunoassay.MAIN OUTCOME MEASURESPlasma adrenomedullin concentration and its correlation with systolic and diastolic function.RESULTS31 patients (40%) had isolated diastolic dysfunction (ejection fraction > 50%), and the remaining 46 had a depressed ejection fraction (< 50%). Of the patients with diastolic dysfunction, 17 had a restrictive filling pattern. In all but one of these there was coexisting systolic failure (χ2 = 10.7, p = 0.001). Patients with systolic heart failure and a restrictive filling pattern (group 1, n = 16) had a higher plasma adrenomedullin than those with systolic failure and a non-restrictive filling pattern (group 2, n = 30) or with isolated diastolic heart failure and a non-restrictive filling pattern (group 3, n = 30) (mean (SEM): 91.7 (21.1) v 38.4 (8.8) v 34.0 (6.5) pmol/l, both p < 0.05). All heart failure values were higher (p < 0.01) than the control value (6.9 (1.2) pmol/l). Ejection fraction and left ventricular dimensions were similar in groups 1 and 2. Plasma adrenomedullin did not correlate with ejection fraction or New York Heart Association functional class. Stepwise multiple regression analysis showed that the presence of a restrictive filling pattern was the only independent variable associated with a high plasma adrenomedullin.CONCLUSIONSPlasma adrenomedullin concentrations in patients with heart failure are determined by the presence of diastolic dysfunction, and are especially raised in the presence of a restrictive filling pattern. There appears to be no correlation with systolic dysfunction.

Role of Diastole in Left Ventricular Function, II: Diagnosis and Treatment

2004 ◽  
Vol 13 (6) ◽  
pp. 453-466 ◽  
Author(s):  
Shannan K. Hamlin ◽  
Penelope S. Villars ◽  
Joseph T. Kanusky ◽  
Andrew D. Shaw
Keyword(s):  
Heart Failure ◽  
Diastolic Dysfunction ◽  
Left Atrial ◽  
Diastolic Heart Failure ◽  
Systolic Heart Failure ◽  
Clinical Signs ◽  
Left Ventricular ◽  
Exercise Intolerance ◽  
Radiographic Findings ◽  
Ventricular Compliance

Left ventricular diastolic dysfunction plays an important role in congestive heart failure. Although once thought to be lower, the mortality of diastolic heart failure may be as high as that of systolic heart failure. Diastolic heart failure is a clinical syndrome characterized by signs and symptoms of heart failure with preserved ejection fraction (0.50) and abnormal diastolic function. One of the earliest indications of diastolic heart failure is exercise intolerance followed by fatigue and, possibly, chest pain. Other clinical signs may include distended neck veins, atrial arrhythmias, and the presence of third and fourth heart sounds. Diastolic dysfunction is difficult to differentiate from systolic dysfunction on the basis of history, physical examination, and electrocardiographic and chest radiographic findings. Therefore, objective diagnostic testing with cardiac catheterization, Doppler echocardiography, and possibly measurement of serum levels of B-type natriuretic peptide is often required. Three stages of diastolic dysfunction are recognized. Stage I is characterized by reduced left ventricular filling in early diastole with normal left ventricular and left atrial pressures and normal compliance. Stage II or pseudonormalization is characterized by a normal Doppler echocardiographic transmitral flow pattern because of an opposing increase in left atrial pressures. This normalization pattern is a concern because marked diastolic dysfunction can easily be missed. Stage III, the final, most severe stage, is characterized by severe restrictive diastolic filling with a marked decrease in left ventricular compliance. Pharmacological therapy is tailored to the cause and type of diastolic dysfunction.

Abstract 3360: Depressed Left Atrial Function and its Relation to Left Ventricular Filling Pressure in Systolic Heart Failure Patients.

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Erberto Carluccio ◽  
Macello Chinali ◽  
Paolo Biagioli ◽  
Daniela Girfoglio ◽  
Marina De Marco ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Atrial ◽  
Diastolic Pressure ◽  
Nyha Class ◽  
Systolic Heart Failure ◽  
Tissue Doppler ◽  
Left Ventricular ◽  
Atrial Function ◽  
Lv Function ◽  
Filling Pattern

Background : In uncomplicated hypertensive patients with preserved left ventricular (LV) function, enhanced left atrial systolic force (LASF) is associated with LV hypertrophy. In contrast, in patients with prevalent cardiovascular disease, reduced LASF has been shown to be associated with incident atrial fibrillation and poor cardiovascular prognosis. To date the relation between LASF and LV filling pressures in patients with systolic heart failure (HF) has not been adequately investigated. Methods : Doppler echocardiographic measurements of LV systolic, diastolic, and Tissue-Doppler longitudinal function, were obtained in 108 patients (66±12 years; 20% women) with systolic HF [NYHA class III; ejection fraction <40% (mean EF%=27.7±7.7%)]. LASF was calculated from mitral orifice area and transmitral peak A velocity. Population study was dichotomized according to the presence or absence of restrictive filling pattern (RF), defined as DT <150 ms. LV end-diastolic pressure (LVEDP) was derived combining transmitral peak E velocity and tissue Doppler E’ (E/E’ ratio). Results : In the overall population, LASF averaged 10.7±5.8 kdynes. LASF was significantly reduced in patients showing RF (n = 43; 39.8% of study population) compared to non-RF patients (8.1±4.8 vs 12.5±5.8 kdynes, p<0.0001). Consistent with this finding, LVEDP was significantly higher in RF patients (p<0.001). In RF patients, LASF was correlated positively with EF% (r=0.23, p<0.05) and TD systolic peak velocity (r=0.39, p<0.0001), and negatively with isovolumic relaxation time (r=0.68, p<0.0001). In additional analysis comparing quartiles of LV end-diastolic pressure, LASF decreased with increasing quartiles of LV end-diastolic pressure (13.7±7 kdynes vs 12±7 kdynes vs 10.6±5 kdynes vs 8±4 kdynes; p for trend <0.01). Conclusions : In systolic HF patients in class NYHA III, left atrial systolic force is reduced in the presence of restrictive filling pattern due in part to increased LV end-diastolic pressure, also associated with reduced LV systolic performance. In CHF patients, increased LVEDP partially blunts LA atrial function, and might be considered as an index of atrial afterload.

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