Force- and relaxation-frequency relations in patients with diastolic heart failure - 18/08/11
, Masaki Tanabe, MD a, Kaoru Dohi, MD a, Kaoru Funabiki-Yamanaka, MD a, Naoki Fujimoto, MD a, Tairo Kurita, MD a, Takashi Tanigawa, MD a, Tetsuya Kitamura, MD a, Masaaki Ito, MD a, Tsutomu Nobori, MD b, Takeshi Nakano, MD aRésumé |
Background |
Chronotropic effects on myocardial contractility (the positive force-frequency relation) and relaxation (the positive relaxation-frequency relation) are impaired in patients with congestive heart failure and depressed left ventricular (LV) ejection fraction (systolic heart failure [SHF]). However, the force- and relaxation-frequency relation and LV-arterial coupling in patients with diastolic heart failure (DHF) has not been fully investigated.
Methods and Results |
To examine inotropic and lusitropic responsiveness to atrial pacing, LV pressure-volume relations were measured using a conductance catheter and microtip manometer in patients with DHF (n = 18) and SHF (n = 11). In patients with SHF, an increase in heart rate by 40 beat/min did not affect LV end-systolic elastance (Ees), which reflects LV contractility, or the time constant of LV relaxation. By contrast, in patients with DHF, an increase in heart rate by 40 beat/min significantly enhanced Ees (2.1 vs 2.9 mm Hg/mL, P < .05) but not the time constant. Furthermore, LV-arterial coupling, quantified as Ees/arterial elastance, was impaired during pacing in patients with DHF (1.1 vs 0.8, P < .05) as well as SHF.
Conclusions |
In patients with DHF, the force-frequency relation was preserved, but the relaxation-frequency relation was impaired. Furthermore, LV-arterial coupling was impaired as heart rate increased, which may be related to the impaired LV function. These results suggest that the impaired relaxation-frequency relation and exacerbated LV-arterial coupling during tachycardia may be an important therapeutic target in patients with DHF.
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Vol 152 - N° 5
P. 966.e1-966.e7 - novembre 2006 Retour au numéro
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