Older patients with heart failure and preserved ejection fraction had reduced percent changes in end-diastolic volume (-7% vs -17%) during transition to head-up tilt compared to healthy controls.
Observational (n=73)
Single-blind
No
Do elderly patients with HFPEF have reduced LV distensibility in response to postural change compared to healthy controls?
Elderly patients with HFPEF exhibit reduced LV distensibility in response to postural changes, supporting the hypothesis that a blunted Frank-Starling mechanism contributes to HFPEF pathophysiology.
Absolute Event Rate: -7% vs -17%
p-value: p=0.003
Most elderly persons with heart failure have a preserved left ventricular (LV) ejection fraction (HFPEF). The pathophysiology of this disorder is not well understood, and there are conflicting data regarding the role of decreased LV distensibility. To assess LV distensibility over a range of preload conditions while minimizing the large, confounding changes in contractility, afterload, and heart rate characteristic of exercise, we measured LV end-diastolic volume (EDV), stroke volume (SV), and cardiac output (CO) using two-dimensional echocardiography in 48 elderly (mean age, 69 yr) HFPEF patients and 25 healthy age-matched controls during quiet supine rest, 45 degrees head-up tilt (HUT), and 45 degrees head-down tilt (HDT). As a result, when compared with controls, HFPEF patients had reduced percent changes in EDV (-7 +/- 2 vs. -17 +/- 2%; P = 0.003), SV (-7 +/- 3 vs. -27 +/- 2%; P = 0.003), and CO (-6 +/- 4 vs. -34 +/- 4%; P = 0.001) during the transition from supine to HUT. HFPEF also had reduced percent changes in EDV (8 +/- 2 vs. 15 +/- 2%; P = 0.02), SV (11 +/- 3 vs. 21 +/- 3%; P = 0.002), and CO (1 +/- 4 vs. 12 +/- 4%; P = 0.04) during the transition from HUT to HDT. In conclusion, HFNEF patients have reduced LV distensibility in response to postural change, resulting in blunted EDV, SV, and CO. This provides further support for the hypothesis that a blunted Frank-Starling mechanism may contribute to the pathophysiology of HFPEF.
John et al. (Mon,) conducted a observational in Heart failure with preserved ejection fraction (HFPEF) (n=73). Postural change (45° head-up tilt and 45° head-down tilt) vs. Healthy age-matched controls was evaluated on Percent change in end-diastolic volume (EDV) from supine to head-up tilt (p=0.003). Older patients with heart failure and preserved ejection fraction had reduced percent changes in end-diastolic volume (-7% vs -17%) during transition to head-up tilt compared to healthy controls.