What is the clinical evidence from this study?

Study design: Case-Control. Population: Heart failure with normal ejection fraction (HFNEF) (n=70). Intervention: Dobutamine stress echocardiography vs. Controls. Primary outcome: Ea, E/Ea ratio, and 6-minute walk distance during stress.

What does this research mean for the field?

Patients with heart failure and normal ejection fraction (HFNEF) have impaired diastolic reserve, leading to stress-induced increases in left ventricular end-diastolic pressure that cause exercise intolerance. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

October 23, 2009Open Access

Lack of Diastolic Reserve in Patients With Heart Failure and Normal Ejection Fraction

Key Result

Dobutamine stress echocardiography demonstrated that patients with HFNEF have impaired diastolic reserve, with decreased Ea and increased E/Ea during stress compared to controls.

Study Design

Type

Case-Control (n=70)

Structured PICO

Does dobutamine stress echocardiography reveal impaired diastolic reserve in patients with heart failure and normal ejection fraction compared to controls?

Population

70 participants, comprising 41 patients with heart failure and normal ejection fraction (HFNEF) and 29 controls.

Intervention

Dobutamine stress echocardiography with color tissue Doppler imaging

Comparator

Controls undergoing the same stress echocardiography protocol

Outcome

Echocardiographic parameters of systolic and diastolic function (Wall motion score index, Sm, Sa, Ea, Aa, E/Ea) at rest and peak stresssurrogate

Patients with HFNEF exhibit impaired diastolic reserve during stress, which correlates with exercise intolerance.

Abstract

BACKGROUND: The genesis of symptoms in patients with heart failure (HF) and normal ejection fraction (HFNEF) is unclear. Most investigations of HFNEF have focused on cardiac function at rest although most of these patients are breathless only on exercise. Stress-induced impairment in systolic or diastolic function could result in these symptoms. Method and Result- Forty-one patients with HFNEF and 29 controls underwent dobutamine stress echocardiography with color tissue Doppler imaging. Wall motion score index and regional myocardial systolic velocity (Sm) were measured at and peak stress. Systolic (Sa), early diastolic (Ea), and late diastolic (Aa) mitral annular velocities were averaged over the 6 periannular sites. Mitral annular long-axis velocity was lower in the HFNEF than controls at rest. Global, regional, and long-axis systolic function did not worsen with stress in the HFNEF group. The Ea decreased and the E/Ea increased with stress in the HFNEF but not in controls. The 6-minute walk distance was shorter and negatively correlated to the E/EA ratio at rest and stress in the HFNEF group. CONCLUSIONS: Impaired diastolic reserve results in stress-induced increase in the left ventricular end-diastolic pressure in patients with HFNEF giving rise to exercise intolerance.