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Decreased cardiac functional reserve in heart failure with preserved systolic function. J Card Fail 2011 Apr;17(4):301-8

Date

03/29/2011

Pubmed ID

21440868

Pubmed Central ID

PMC3073553

DOI

10.1016/j.cardfail.2010.11.004

Scopus ID

2-s2.0-79953225133   38 Citations

Abstract

BACKGROUND: Heart failure in patients with preserved left ventricular systolic function (HFpEF) is a prevalent disease characterized by exercise intolerance with poorly understood pathophysiology. We hypothesized that recruitable contractility is impaired in HFpEF, accounting for the appearance of symptoms with exertion.

METHODS AND RESULTS: Echocardiographic analysis of myocardial performance was performed at baseline and after a modified dobutamine protocol (max dose 16 μg/kg/min) in participants with known HFpEF and age- and gender-matched controls. The primary outcome variable was change in contractile reserve, measured as a change in ejection fraction (EF). Recruitable contractility was decreased in HFpEF participants compared with control subjects (HFpEF 0.4 ± 1.9% vs control 19.0 ± 1.4%; P < .001). During dobutamine infusion, velocities increased in control participants but remained unchanged in the HFpEF group, yielding a significant difference between groups (P < .05) for both longitudinal displacement and velocity.

CONCLUSIONS: Patients with HFpEF have an impaired contractile response to adrenergic stimulation. The blunted response to adrenergic stimulation in the HFpEF group suggests that these patients may be unable to respond to periods of increased cardiac demand. This inability to increase contractility appropriately suggests abnormalities of systolic function in this disease and may contribute to exertional intolerance in HFpEF.

Author List

Norman HS, Oujiri J, Larue SJ, Chapman CB, Margulies KB, Sweitzer NK

Author

James Oujiri MD Associate Professor in the Medicine department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adult
Aged
Aged, 80 and over
Case-Control Studies
Dobutamine
Echocardiography, Stress
Female
Heart Failure, Diastolic
Humans
Male
Middle Aged
Myocardial Contraction
Stroke Volume
Systole
Ventricular Function
Ventricular Function, Left