Restrictive left ventricular filling pattern does not result from increased left atrial pressure alone.
BACKGROUND
The restrictive filling pattern seen with severe heart failure (HF) may be due to diastolic dysfunction with elevated left ventricular (LV) diastolic pressure or may be merely a manifestation of an overfilled LV as a result of increased left atrial (LA) pressure. We investigated whether the LV restrictive filling pattern is due to elevated LA pressure alone.


RESULTS
We studied conscious dogs instrumented to measure LA pressure, LV pressure, and 3 LV diameters. LV filling dynamics were evaluated in 2 situations with similar elevations of LA pressure: in normal animals after rapid volume loading with dextran 500 mL and in animals with pacing-induced HF with restrictive filling. With HF, there was increased LV chamber stiffness and slow relaxation. Volume loading and HF had similar heart rates (129+/-19 versus 131+/-15 bpm) and LA pressure (22.1+/-5.8 versus 22.6+/-3.3 mm Hg). The peak early filling rate (E) was increased with both HF and volume loading. However, in HF, the peak mitral annular velocity (E') was decreased and delayed, and the E deceleration time was shorter. In contrast, with volume loading, E' was increased and not delayed.


CONCLUSIONS
The restrictive filling pattern is distinguished from overfilling of a normal ventricle by a reduced and delayed E' and a shortened E deceleration time that reflect slow relaxation and increased LV stiffness.
Masutani
Satoshi
S
Cardiology Section, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157-1045, USA.
Little
William C
WC
Hasegawa
Hiroshi
H
Cheng
Heng-Jie
HJ
Cheng
Che-Ping
CP
D000818:Animals; D016279:Atrial Function, Left; D001783:Blood Flow Velocity; D001794:Blood Pressure; D004285:Dogs; D006325:Heart Atria / Q000503:physiopathology*; D006333:Heart Failure / Q000503:physiopathology*; D018487:Ventricular Dysfunction, Left; D017725:Ventricular Pressure