Published Online
on October 22, 2009

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Original Article

Lack of Diastolic Reserve in Patients with Heart Failure and Normal Ejection Fraction.

Sudipta Chattopadhyay¹; Mohammed F. Alamgir; Nikolay P. Nikitin; Alan S. Rigby; Andrew L. Clark and John G.F. Cleland

University of Hull, Kingston-upon-Hull, UK

^* Corresponding author; email: diptochatt{at}yahoo.co.uk

Background—The genesis of symptoms in patients with heart failure (HF) and normal ejection fraction (HFNEF) is unclear. Most investigations of HFNEF have focused on cardiac function at rest though most of these patients are breathless only on exercise. Stress induced impairment in systolic or diastolic function could result in these symptoms.

Methods and Results—Forty-one patients with HFNEF and 29 controls underwent dobutamine stress echocardiography (DSE) with colour tissue Doppler imaging (cTDI). Wall motion score index (WMSI) and regional myocardial systolic velocity (Sm) were measured at and peak stress. Systolic (Sa), early diastolic (Ea) and late diastolic (Aa) mitral annular velocities were averaged over the 6 peri-annular sites. Mitral annular long axis velocity was lower in the HFNEF than controls at rest. Global, regional and long axis systolic function did not worsen with stress in the HFNEF group. The Ea decreased and the E/Ea increased with stress in the HFNEF but not in controls. The 6 minute walk distance was shorter and negatively correlated to the E/Em ratio at rest and stress in the HFNEF group.

Conclusion—Impaired diastolic reserve results in stress-induced increase in the left ventricular end-diastolic pressure (LVEDP) in patients with HFNEF giving rise to exercise intolerance.

Key Words: diastolic heart failure • exercise intolerance • heart failure with normal ejection fraction • stress echocardiography • tissue Doppler imaging