Author(s): Phan TT, Abozguia K, Nallur Shivu G, Mahadevan G, Ahmed I, et al.
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 (31)P 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.
Referred From: https://www.ncbi.nlm.nih.gov/pubmed/19628114
Author(s): Evans GA
Author(s): Ruegg C, Tissot JD, Farmer P, Mariotti A
Author(s): Owan TE, Hodge DO, Herges RM, Jacobsen SJ, Roger VL, et al.
Author(s): Bhatia RS, Tu JV, Lee DS, Austin PC, Fang J, et al.
Author(s): Borlaug BA, Paulus WJ
Author(s): Zile MR, Baicu CF, Gaasch WH
Author(s): Paulus WJ, Tschope C, Sanderson JE, Rusconi C, Flachskampf FA, et al.
Author(s): Borlaug BA, Lam CS, Roger VL, Rodeheffer RJ, Redfield MM
Author(s): Tan YT, Wenzelburger F, Lee E, Heatlie G, Leyva F, et al.
Author(s): Borlaug BA, Olson TP, Lam CS, Flood KS, Lerman A, et al.
Author(s): Ahmed SH, Clark LL, Pennington WR, Webb CS, Bonnema DD, et al.
Author(s): Gonzalez A, Lopez B, Querejeta R, Zubillaga E, Echeverria T, et al.
Author(s): Tschope C, Bock CT, Kasner M, Noutsias M, Westermann D, et al.
Author(s): Niethammer M, Sieber M, von Haehling S, Anker SD, Munzel T, et al.
Author(s): Borlaug BA, Melenovsky V, Russell SD, Kessler K, Pacak K, et al.
Author(s): Phan TT, Shivu GN, Abozguia K, Davies C, Nassimizadeh M, et al.
Author(s): Phan TT, Shivu GN, Abozguia K, Davies C, Nassimizadeh M, et al.
Author(s): Lenzen MJ, Scholte op Reimer WJ, Boersma E, Vantrimpont PJ, Follath F, et al.
Author(s): McMurray JJ, Carson PE, Komajda M, McKelvie R, Zile MR, et al.
Author(s): Ahmed A, Rich MW, Fleg JL, Zile MR, Young JB, et al.
Author(s): Yusuf S, Pfeffer MA, Swedberg K, Granger CB, Held P, et al.
Author(s): Cleland JG, Tendera M, Adamus J, Freemantle N, Polonski L, et al.
Author(s): Junhong W, Jing Y, Jizheng M, Shushu Z, Xiangjian C, et al.
Author(s): Kittleson MM, Ye SQ, Irizarry RA, Minhas KM, Edness G, et al.
Author(s): Wellcome Trust Case Control Consortium
Author(s): Levy D, Larson MG, Benjamin EJ, Newton-Cheh C, Wang TJ, et al.
Author(s): Newton-Cheh C, Johnson T, Gateva V, Tobin MD, Bochud M, et al.
Author(s): Levy D, Ehret GB, Rice K, Verwoert GC, Launer LJ, et al.
Author(s): Lander ES, Linton LM, Birren B, Nusbaum C, Zody MC, et al.
Author(s): Frazer KA, Ballinger DG, Cox DR, Hinds DA, Stuve LL, et al.
Author(s): Berhane BT, Zong C, Liem DA, Huang A, Le S, et al.
Author(s): Rauchhaus M, Doehner W, Francis DP, Davos C, Kemp M, et al.
Author(s): Hinglais N, Heudes D, Nicoletti A, Mandet C, Laurent M, et al.
Author(s): Martos R, Baugh J, Ledwidge M, O'Loughlin C, Conlon C, et al.
Author(s): Witt H, Schubert C, Jaekel J, Fliegner D, Penkalla A, et al.
Author(s): Villari B, Campbell SE, Schneider J, Vassalli G, Chiariello M, et al.
Author(s): Villari B, Campbell SE, Schneider J, Vassalli G, Chiariello M, et al.
Author(s): Kruger M, Kotter S, Grutzner A, Lang P, Andresen C, et al.
Author(s): Borbely A, Falcao-Pires I, van Heerebeek L, Hamdani N, Edes I, et al.
Author(s): Hidalgo C, Hudson B, Bogomolovas J, Zhu Y, Anderson B, et al.
Author(s): riones AM, Arribas SM, Salaices M
Author(s): Kawaguchi M, Hay I, Fetics B, Kass DA
Author(s): Kawaguchi M, Hay I, Fetics B, Kass DA
Author(s): Hundley WG, Kitzman DW, Morgan TM, Hamilton CA, Darty SN, et al.
Author(s): Kelly RP, Tunin R, Kass DA
Author(s): Durier S, Fassot C, Laurent S, Boutouyrie P, Couetil JP, et al.
Author(s): Mantero A, Gentile F, Gualtierotti C, Azzollini M, Barbier P, et al.
Author(s): Lam CS, Roger VL, Rodeheffer RJ, Bursi F, Borlaug BA, et al.
Author(s): Stuyvers BD, Miura M, ter Keurs HE
Author(s): Kokubo M, Uemura A, Matsubara T, Murohara T
Author(s): Molkentin JD
Author(s): Gallego-Delgado J, Lazaro A, Osende JI, Esteban V, Barderas MG, et al.
Author(s): Wong WT, Wong SL, Tian XY, Huang Y
Author(s): Thomas SR, Witting PK, Drummond GR
Author(s): Landmesser U, Dikalov S, Price SR, McCann L, Fukai T, et al.
Author(s): Silberman GA, Fan TH, Liu H, Jiao Z, Xiao HD, et al.
Author(s): Regitz-Zagrosek V, Brokat S, Tschope C
Author(s): Laule M, Meisel C, Prauka I, Cascorbi I, Malzahn U, et al.
Author(s): Hart EC, Charkoudian N, Wallin GG, Curry TB, Eisenach JH, et al.
Author(s): Stein PK, Barzilay JI
Author(s): Bauer A, Malik M, Schmidt G, Barthel P, Bonnemeier H, et al.
Author(s): Beery AK, Zucker I
Author(s): Geller SE, Koch A, Pellettieri B, Carnes M
Author(s): Foulkes MA
Author(s): Shannon P, Markiel A, Ozier O, Baliga NS, Wang JT, et al.
