title: Restrictive left ventricular filling patterns in very old patients with congestive heart failure: clinical correlates and prognostic significance.
abstract: OBJECTIVE
  In certain younger patients with congestive heart failure (CHF), Doppler/echocardiography has identified a "restrictive" pattern of early diastolic ventricular filling characterized by very rapid early filling and a steep deceleration slope. We asked whether a similar restrictive pattern can be identified in very old patients with CHF, and if so, what are its clinical correlates and prognostic implications.
  
  
  METHODS
  Retrospective cohort with prospective follow-up.
  
  
  METHODS
  Academic long-term care facility.
  
  
  METHODS
  Thirty-nine residents with clinical CHF (age 89 +/- 5 (SD) years)
  
  
  METHODS
  Transmitral Doppler flow, clinical characteristics, recurrent CHF episodes, hospitalizations, and mortality were measured.
  
  
  RESULTS
  Fifteen (38%) of the subjects had restrictive filling patterns, characterized by a ratio of early to late flow (E/A) > 1.00 and 24 (62%) had nonrestrictive patterns. The restrictive pattern was associated with a longer duration of CHF, more angina, and higher rate of symptomatic recurrences of CHF.
  
  
  CONCLUSIONS
  A restrictive diastolic filling pattern may represent a late stage in the evolution of congestive heart failure when left ventricular filling pressure is markedly increased. The treatment of CHF in older patients may need to account for different patterns of diastolic filling.
authors.affiliation: Beth Israel Hospital Department of Medicine, Boston MA 02131, USA.
authors.forename: L A
authors.initials: LA
authors.lastname: Lipsitz
authors.forename: N
authors.initials: N
authors.lastname: Byrnes
authors.forename: M
authors.initials: M
authors.lastname: Hossain
authors.forename: P
authors.initials: P
authors.lastname: Douglas
authors.forename: C A
authors.initials: CA
authors.lastname: Waksmonski
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003971:Diastole; D015150:Echocardiography, Doppler; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology*; D006801:Humans; D015993:Life Tables; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D012189:Retrospective Studies; D016019:Survival Analysis; D016277:Ventricular Function, Left