Circulation, Vol 89, 2241-2250, Copyright © 1994 by American Heart Association
M Ohno, CP Cheng and WC Little
BACKGROUND: The mechanism of the alterations in the pattern of left
ventricular (LV) filling during the development of congestive heart failure
(CHF) is not fully understood. METHODS AND RESULTS: We studied six
conscious dogs instrumented to measure LV and left atrial (LA) pressures
and LV volume as CHF was induced by rapid pacing. Diastolic filling
dynamics were serially measured over 4 weeks during normal sinus rhythm.
Four days after we initiated pacing, the peak early diastolic filing rate
decreased from 108 +/- 24 to 88 +/- 27 mL/s (P < .05) as the maximal
early diastolic LA-LV pressure gradient decreased associated with a slowing
of the rate of LV relaxation. Subsequently, the peak early filling rate
progressively increased, returning to control at 1 week, and by the fourth
week, it had increased to 168 +/- 39 mL/s (P < .05). These changes in
early filling rates occurred as the maximal early diastolic LA-LV pressure
gradient increased in association with a progressive increase in LV
pressure despite further progressive slowing of the rate of LV relaxation.
Throughout the development of CHF, peak early filling rate and the maximal
LA-LV pressure gradient correlated (r = .99, P < .001). The early
filling deceleration rate increased and deceleration time progressively
decreased over the 4 weeks as LV stiffness and net LA plus LV stiffness
increased (P < .05). As predicted by a theoretical analysis, the
deceleration time was linearly related to the reciprocal of the square root
of LV stiffness (r = .94, P < .01). CONCLUSIONS: Early in CHF, slowing
of LV relaxation reduces the maximal early diastolic LA-LV pressure
gradient, decreasing the peak early filling rate. As CHF progresses, this
is overcome by an increase in LA pressure that augments the early diastolic
LA-LV pressure gradient, increasing peak early filling rate. Increasing LV
stiffness during the development of CHF progressively shortens the early
filling deceleration time and augments the early filling deceleration rate.
These observations suggest that the early filling deceleration time
reflects LV stiffness.
ARTICLES
Mechanism of altered patterns of left ventricular filling during the development of congestive heart failure
Cardiology Section, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, NC 27157-1045.
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