title: Restrictive left ventricular filling pattern does not result from increased left atrial pressure alone.
abstract: 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.
authors.affiliation: Cardiology Section, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157-1045, USA.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Masutani
authors.forename: William C
authors.initials: WC
authors.lastname: Little
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hasegawa
authors.forename: Heng-Jie
authors.initials: HJ
authors.lastname: Cheng
authors.forename: Che-Ping
authors.initials: CP
authors.lastname: Cheng
mesh_terms: 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