Pacing-induced heart failure with restrictive filling is distinguished from volume loading in normal ventricles by a reduced and delayed peak mitral annular velocity and shortened E deceleration time.
Does pacing-induced HF with restrictive filling differ from volume loading in LV filling dynamics in conscious dogs?
The restrictive filling pattern in heart failure is distinguished from simple volume overload by reduced and delayed E' and shortened E deceleration time, reflecting increased LV stiffness rather than just elevated LA pressure.
BACKGROUND: The restrictive filling pattern seen with severe heart failure (HF) may be due to diastolic dysfunction with elevated left ventricular (LV) diastolic pressure or may be merely a manifestation of an overfilled LV as a result of increased left atrial (LA) pressure. We investigated whether the LV restrictive filling pattern is due to elevated LA pressure alone. METHODS AND RESULTS: We studied conscious dogs instrumented to measure LA pressure, LV pressure, and 3 LV diameters. LV filling dynamics were evaluated in 2 situations with similar elevations of LA pressure: in normal animals after rapid volume loading with dextran 500 mL and in animals with pacing-induced HF with restrictive filling. With HF, there was increased LV chamber stiffness and slow relaxation. Volume loading and HF had similar heart rates (129+/-19 versus 131+/-15 bpm) and LA pressure (22.1+/-5.8 versus 22.6+/-3.3 mm Hg). The peak early filling rate (E) was increased with both HF and volume loading. However, in HF, the peak mitral annular velocity (E') was decreased and delayed, and the E deceleration time was shorter. In contrast, with volume loading, E' was increased and not delayed. CONCLUSIONS: The restrictive filling pattern is distinguished from overfilling of a normal ventricle by a reduced and delayed E' and a shortened E deceleration time that reflect slow relaxation and increased LV stiffness.
Masutani et al. (Tue,) conducted a other in Heart failure. Pacing-induced heart failure vs. Rapid volume loading with dextran 500 mL in normal animals was evaluated on Left ventricular filling dynamics (peak early filling rate E, peak mitral annular velocity E', and E deceleration time). Pacing-induced heart failure with restrictive filling is distinguished from volume loading in normal ventricles by a reduced and delayed peak mitral annular velocity and shortened E deceleration time.