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  Heart Failure With Preserved Ejection Fraction Is Characterized by Dynamic Impairment of Active Relaxation and Contraction of the Left Ventricle on Exercise and Associated With Myocardial Energy Deficiency

Phan, T., Abozguia, K., Nallur Shivu, G., Mahadevan, G., Ahmed, I., Williams, L., et al. (2009). Heart Failure With Preserved Ejection Fraction Is Characterized by Dynamic Impairment of Active Relaxation and Contraction of the Left Ventricle on Exercise and Associated With Myocardial Energy Deficiency. Journal of the American College of Cardiology, 54(5), 402-409. doi:10.1016/j.jacc.2009.05.012.

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Item Permalink: http://hdl.handle.net/11858/00-001M-0000-0013-C3EF-8 Version Permalink: http://hdl.handle.net/21.11116/0000-0002-BF73-6
Genre: Journal Article

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Phan, TT, Author
Abozguia, K, Author
Nallur Shivu , G, Author
Mahadevan, G, Author
Ahmed , I, Author
Williams, L, Author
Dwivedi, G, Author
Patel, K, Author
Steendijk, P, Author
Ashrafian , H, Author
Henning, A1, Author              
Frenneaux, M, Author
Affiliations:
1Institute for Biomedical Engineering, University and ETH Zurich, ou_persistent22              

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 Abstract: Objectives We sought to evaluate the role of exercise-related changes in left ventricular (LV) relaxation and of LV contractile function and vasculoventricular coupling (VVC) in the pathophysiology of heart failure with preserved ejection fraction (HFpEF) and to assess myocardial energetic status in these patients. Background To date, no studies have investigated exercise-related changes in LV relaxation and VVC as well as in vivo myocardial energetic status in patients with HFpEF. Methods We studied 37 patients with HFpEF and 20 control subjects. The VVC and time to peak LV filling (nTTPF, a measure of LV active relaxation) were assessed while patients were at rest and during exercise by the use of radionuclide ventriculography. Cardiac energetic status (creatine phosphate/adenosine triphosphate ratio) was assessed by the use of 31P magnetic resonance spectroscopy at 3-T. Results When patients were at rest, nTTPF and VVC were similar in patients with HFpEF and control subjects. The cardiac creatine phosphate/adenosine triphosphate ratio was reduced in patients with HFpEF versus control subjects (1.57 ± 0.52 vs. 2.14 ± 0.63; p = 0.003), indicating reduced energy reserves. Peak maximal oxygen uptake and the increase in heart rate during maximal exercise were lower in patients with HFpEF versus control subjects (19 ± 4 ml/kg/min vs. 36 ± 8 ml/kg/min, p < 0.001, and 52 ± 16 beats/min vs. 81 ± 14 beats/min, p < 0.001). The relative changes in stroke volume and cardiac output during submaximal exercise were lower in patients with HFpEF versus control subjects (ratio exercise/rest: 0.99 ± 0.34 vs. 1.25 ± 0.47, p = 0.04, and 1.36 ± 0.45 vs. 2.13 ± 0.72, p < 0.001). The nTTPF decreased during exercise in control subjects but increased in patients with HFpEF (−0.03 ± 12 s vs. +0.07 ± 0.11 s; p = 0.005). The VVC decreased on exercise in control subjects but was unchanged in patients with HFpEF (−0.01 ± 0.15 vs. −0.25 ± 0.19; p < 0.001). Conclusions Patients with HFpEF have reduced cardiac energetic reserve that may underlie marked dynamic slowing of LV active relaxation and abnormal VVC during exercise.

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 Dates: 2009-07
 Publication Status: Published in print
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 Table of Contents: -
 Rev. Type: -
 Identifiers: DOI: 10.1016/j.jacc.2009.05.012
BibTex Citekey: PhanANMAWDPSAHF2009
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Title: Journal of the American College of Cardiology
Source Genre: Journal
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Pages: - Volume / Issue: 54 (5) Sequence Number: - Start / End Page: 402 - 409 Identifier: ISSN: 1133-4304
CoNE: https://pure.mpg.de/cone/journals/resource/110978984252272