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Isolated left ventricular diastolic dysfunction: implications for exercise left ventricular performance in patients without congestive heart failure.

Vittorio Palmieri·Cesare Russo·Emiliano A Palmieri·Emma Arezzi·Salvatore Pezzullo·Stefana Minichiello·Stefania Martino·Paola Migliaresi·Aldo Celentano
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Abstract

OBJECTIVE: Clinical relevance of left ventricular (LV) diastolic dysfunction in the absence of congestive heart failure (CHF) and LV systolic dysfunction is not fully established. METHODS: Asymptomatic outpatients, sedentary, with cardiovascular risk factors but no history of cardiovascular events, underwent echocardiographic evaluation of LV structure and function by standard Doppler, color M-mode, and Doppler tissue methods, and exercise testing with simultaneous noninvasive assessment of LV stroke index and cardiac index. LV ejection fraction less than 50% and significant valvular disease or stress test suggestive of coronary disease were additional exclusion criteria. RESULTS: In 70 patients selected (40 +/- 10 years old, 63% men, 34% hypertensive, 34% diabetic, 4% diabetic and hypertensive, 11% with LV hypertrophy), LV diastolic dysfunction was detected in 26%, which was associated with hypertension, higher LV mass index, lower systolic function, lower peak exercise heart rate, and chronotropic reserve (all P < .05), and with lower peak exercise stroke index and cardiac index (both covariates adjusted P < .05), but not with lower peak exercise metabolic equivalents (P > .5). Abnormal LV relaxation was independently correlated with lower peak exercise cardiac index and stroke index (both P < .05). Peak exercise systolic and cardiac indices were comparable between patients with CHF risk factors (74%) versus those without. CONCLUSIONS: Isolated LV diastolic dysfunction was independently associated with lower peak exercise LV systolic performance in patients without CHF. Its diagnosis may provide a target for aggressive CHF risk management.

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AdultAgedDiastoleExercise TestFemaleHeart FailureHumansMaleMiddle AgedReproducibility of ResultsRisk AssessmentRisk FactorsSensitivity and SpecificityStroke VolumeUltrasonographyVentricular Dysfunction, LeftClinical TrialJournal ArticleResearch Support, Non-U.S. Gov't

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Vittorio Palmieri, Cesare Russo, Emiliano A Palmieri, Emma Arezzi, Salvatore Pezzullo, Stefana Minichiello, Stefania Martino, Paola Migliaresi, Aldo Celentano. 2006. Isolated left ventricular diastolic dysfunction: implications for exercise left ventricular performance in patients without congestive heart failure.. https://doi.org/10.1016/j.echo.2005.12.011

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