PMID- 25691001
OWN - NLM
STAT- MEDLINE
DCOM- 20160202
LR  - 20181113
IS  - 1097-6795 (Electronic)
IS  - 0894-7317 (Print)
IS  - 0894-7317 (Linking)
VI  - 28
IP  - 5
DP  - 2015 May
TI  - Altered spatial distribution of the diastolic left ventricular pressure 
      difference in heart failure.
PG  - 597-605.e1
LID - S0894-7317(15)00003-6 [pii]
LID - 10.1016/j.echo.2015.01.002 [doi]
AB  - BACKGROUND: The left ventricle fills in early diastole because of a progressive 
      intraventricular pressure difference (IVPD) that extends from the left atrium to 
      the left ventricular (LV). The aim of this study was to test the hypothesis that 
      in patients with symptomatic heart failure (HF) regardless of LV ejection 
      fraction (EF), an increase in left atrial (LA) pressure maintains early diastolic 
      filling because of a preserved IVPD from the left atrium to the mid left 
      ventricle, while the IVPD from the mid left ventricle to the apex is diminished 
      because of reduced LV suction. METHODS: One hundred fifty-one patients with HF 
      (50 with HF with preserved EF [HFpEF; EF >/= 50%] and 101 with HF with reduced EF 
      [HFrEF; EF < 50%]) and 28 normal controls were prospectively enrolled. The IVPDs 
      from the left atrium to the LV apex (total IVPD), the left atrium to the mid left 
      ventricle (basilar IVPD), and the mid left ventricle to the apex (apical IVPD) 
      were determined using color M-mode Doppler echocardiographic data to integrate 
      the Euler equation. The propagation of early diastolic filling was also assessed 
      by color M-mode Doppler. RESULTS: The mean LV EF was 0.63 +/- 0.07 in patients with 
      HFpEF, 0.32 +/- 0.09 in those with HFrEF, and 0.64 +/- 0.06 in controls. Peak early 
      diastolic transmitral flow velocities (E) were similar among the groups, and 
      basilar IVPDs were maintained in the HFpEF and HFrEF groups (HFpEF, 
      1.59 +/- 0.62 mm Hg; HFrEF, 1.49 +/- 0.75 mm Hg; controls, 1.80 +/- 0.61 mm Hg; P = NS, 
      analysis of variance). However, apical IVPDs were decreased in both HF groups 
      (HFpEF, 1.18 +/- 0.56 mm Hg [P < .01 vs controls]; HFrEF, 0.87 +/- 0.48 mm Hg 
      [P < .01 vs controls]; controls, 1.65 +/- 0.62 mm Hg), resulting in decreased total 
      IVPDs in patients with HF (HFpEF, 2.55 +/- 0.80 mm Hg [P < .01 vs controls]; HFrEF, 
      2.16 +/- 0.80 mm Hg [P < .01 vs controls]; controls, 3.17 +/- 0.91 mm Hg). E/e' 
      ratios were increased in patients with HF, consistent with elevated LA pressure. 
      In patients with HF, E was correlated with basilar IVPD but not with apical IVPD, 
      whereas propagation of the filling was correlated with the apical IVPD but not 
      with the basilar IVPD. CONCLUSIONS: In patients with HFpEF and those with HFrEF, 
      apical IVPDs were reduced while basilar IVPDs were maintained by elevated LA 
      pressure, resulting in preserved E.
CI  - Copyright (c) 2015 American Society of Echocardiography. Published by Elsevier Inc. 
      All rights reserved.
FAU - Iwano, Hiroyuki
AU  - Iwano H
AD  - Division of Cardiology, University of Mississippi Medical Center, Jackson, 
      Mississippi.
FAU - Kamimura, Daisuke
AU  - Kamimura D
AD  - Division of Cardiology, University of Mississippi Medical Center, Jackson, 
      Mississippi.
FAU - Fox, Ervin
AU  - Fox E
AD  - Division of Cardiology, University of Mississippi Medical Center, Jackson, 
      Mississippi.
FAU - Hall, Michael
AU  - Hall M
AD  - Division of Cardiology, University of Mississippi Medical Center, Jackson, 
      Mississippi.
FAU - Vlachos, Pavlos
AU  - Vlachos P
AD  - School of Mechanical Engineering, Purdue University, West Lafayette, Indiana.
FAU - Little, William C
AU  - Little WC
AD  - Division of Cardiology, University of Mississippi Medical Center, Jackson, 
      Mississippi. Electronic address: wlittle@umc.edu.
LA  - eng
GR  - R21 HL106276/HL/NHLBI NIH HHS/United States
GR  - 7R21HL106276-03/HL/NHLBI NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
DEP - 20150215
PL  - United States
TA  - J Am Soc Echocardiogr
JT  - Journal of the American Society of Echocardiography : official publication of the 
      American Society of Echocardiography
JID - 8801388
SB  - IM
MH  - Adult
MH  - Diastole
MH  - Echocardiography, Doppler, Color/*methods
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Failure/*diagnostic imaging/physiopathology
MH  - Heart Ventricles/*diagnostic imaging/physiopathology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Prospective Studies
MH  - Ventricular Function, Left/*physiology
MH  - Ventricular Pressure/*physiology
PMC - PMC5441386
MID - NIHMS653668
OTO - NOTNLM
OT  - Color M-mode Doppler imaging
OT  - Heart failure
OT  - Intra-left ventricular pressure difference
OT  - Left ventricular diastolic function
EDAT- 2015/02/19 06:00
MHDA- 2016/02/03 06:00
PMCR- 2017/05/23
CRDT- 2015/02/19 06:00
PHST- 2014/09/23 00:00 [received]
PHST- 2015/02/19 06:00 [entrez]
PHST- 2015/02/19 06:00 [pubmed]
PHST- 2016/02/03 06:00 [medline]
PHST- 2017/05/23 00:00 [pmc-release]
AID - S0894-7317(15)00003-6 [pii]
AID - 10.1016/j.echo.2015.01.002 [doi]
PST - ppublish
SO  - J Am Soc Echocardiogr. 2015 May;28(5):597-605.e1. doi: 
      10.1016/j.echo.2015.01.002. Epub 2015 Feb 15.