Left Ventricular Volume-Time Relation in Patients With Heart Failure With Preserved Ejection Fraction

• Published in: The American journal of cardiology 2018-03, Vol.121 (5), p.609-614
• Main Authors: Hieda, Michinari, Parker, Joshua, Rajabi, Tanya, Fujimoto, Naoki, Bhella, Paul S., Prasad, Anand, Hastings, Jeffrey L., Sarma, Satyam, Levine, Benjamin D.
• Format: Article
• Language: English
• Subjects: Aged; Atrial Pressure - physiology; Automation; Blood pressure; Capillary pressure; Cardiovascular disease; Diastole; Diastole - physiology; Echocardiography, Doppler; Ejection fraction; Exercise; Female; Heart; Heart diseases; Heart failure; Heart Failure - diagnostic imaging; Heart Failure - physiopathology; Humans; Intubation; Magnetic resonance imaging; Magnetic Resonance Imaging, Cine; Male; NMR; Nuclear magnetic resonance; Patients; Physical fitness; Pressure; Pulmonary arteries; Pulmonary Wedge Pressure - physiology; Stroke; Stroke Volume - physiology; Ventricle; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - physiopathology
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2017.11.033

Elevated left ventricular (LV) filling pressures are commonly reported in patients with heart failure with preserved ejection fraction (HFpEF) and are associated with impaired relaxation in diastole. Relaxation has been assessed by Doppler, but the methods for doing so are indirect and heavily influenced by loading conditions. The aim of this study is to assess LV volume-time relation in patients with HFpEF, when correcting for left atrial driving pressure and chamber size, using cardiac magnetic resonance imaging (cMRI). Cine short-axis views by cMRI (1.5T-magnet) at 26 Hz were used for measurement of LV volume. We compared the following diastolic parameters: peak filling rate/end-diastolic volume (PFR/EDV); PFR/EDV/pulmonary capillary wedge pressure (PFR/EDV/PCWP); time to PFR (TPFR); and %TPFR for cardiac cycle calculated by cMRI between patients with HFpEF (n = 10, 73 ± 7 years) and age-matched controls (n = 12, 70 ± 3 years). PCWP was significantly greater in the HFpEF group than in controls (HFpEF vs controls: 15.6 ± 5.2 vs 11.2 ± 1.3 mmHg, p = 0.0092). PFR/EDV was significantly slower in the HFpEF group than in controls (2.68 ± 0.85 vs 3.59 ± 0.87/s, p = 0.03), and was nearly 50% slower when corrected for left atrial driving pressure: PFR/EDV/PCWP (0.18 ± 0.07 vs 0.33 ± 0.10/s/mmHg, p = 0.002). In addition, TPFR (246 ± 17.2 vs 188 ± 15.7 ms, p = 0.04) and %TPFR of cardiac cycle (36.4 ± 10.4 vs 25.6 ± 5.9%, p = 0.012) were significantly longer in the HFpEF group than in controls. Patients with HFpEF have an abnormal volume-time relation, including lower PFR/EDV (PFR/EDV/PCWP) and prolonged TPFR, due to the impairment of active relaxation during early diastole.