Published Online
on April 14, 2008

A more recent version of this article appeared on April 22, 2008

This Article Full Text (PDF) CME: Take the course for this article: Circulation: April 22, 2008, Volume 117, Number 16 All Versions of this Article: 117/16/2051    most recent CIRCULATIONAHA.107.716886v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Google Scholar Articles by Westermann, D. Articles by Tschöpe, C. PubMed PubMed Citation Articles by Westermann, D. Articles by Tschöpe, C. Related Collections Congestive Myocardial cardiomyopathy disease Heart failure - basic studies Related Article

Submitted on May 23, 2007
Accepted on January 29, 2008

Role of Left Ventricular Stiffness in Heart Failure With Normal Ejection Fraction

Dirk Westermann MD, Mario Kasner MD, Paul Steendijk PhD, Frank Spillmann MD, Alexander Riad MD, Kerstin Weitmann MSc, Wolfgang Hoffmann MD, MPH, Wolfgang Poller MD, Matthias Pauschinger MD, Heinz-Peter Schultheiss MD, and Carsten Tschöpe MD^*

From the Department of Cardiology and Pneumology, Benjamin Franklin Campus, Charité University Hospital, Berlin, Germany (D.W., M.K., F.S., A.R., W.P., M.P., H.-P.S., C.T.); Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands (P.S.); and Institute for Community Medicine, Ernst-Moritz-Arndt University of Greifswald, Greifswald, Germany (K.W., W.H.).

^* To whom correspondence should be addressed. E-mail: ctschoepe{at}yahoo.com.

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.

Key words: cardiac output • cardiomyopathy • diastole • heart failure • hemodynamics

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Circulation 2008 117: 2041. [Full Text]

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