title: Role of left ventricular stiffness in heart failure with normal ejection fraction.
abstract: BACKGROUND
  Increased left ventricular stiffness is a distinct finding in patients who have heart failure with normal ejection fraction (HFNEF). To elucidate how diastolic dysfunction contributes to heart failure symptomatology during exercise, we conducted a study using an invasive pressure-volume loop approach and measured cardiac function at rest and during atrial pacing and handgrip exercise.
  
  
  RESULTS
  Patients with HFNEF (n=70) and patients without heart failure symptoms (n=20) were enrolled. Pressure-volume loops were measured with a conductance catheter during basal conditions, handgrip exercise, and atrial pacing with 120 bpm to analyze diastolic and systolic left ventricular function. During transient preload reduction, the diastolic stiffness constant was measured directly. Diastolic function with increased stiffness was significantly impaired in patients with HFNEF during basal conditions. This was associated with increased end-diastolic pressures during handgrip exercise and with decreased stroke volume and a leftward shift of pressure-volume loops during atrial pacing.
  
  
  CONCLUSIONS
  Increased left ventricular stiffness contributed to increased end-diastolic pressure during handgrip exercise and decreased stroke volume during atrial pacing in patients with HFNEF. These data suggest that left ventricular stiffness modulates cardiac function in HFNEF patients and suggests that diastolic dysfunction with increased stiffness is a target for treating HFNEF.
authors.affiliation: Department of Cardiology and Pneumology, Benjamin Franklin Campus, Charité University Hospital, Hindenburgdamm 30, 12200 Berlin, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Westermann
authors.forename: Mario
authors.initials: M
authors.lastname: Kasner
authors.forename: Paul
authors.initials: P
authors.lastname: Steendijk
authors.forename: Frank
authors.initials: F
authors.lastname: Spillmann
authors.forename: Alexander
authors.initials: A
authors.lastname: Riad
authors.forename: Kerstin
authors.initials: K
authors.lastname: Weitmann
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Hoffmann
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Poller
authors.forename: Matthias
authors.initials: M
authors.lastname: Pauschinger
authors.forename: Heinz-Peter
authors.initials: HP
authors.lastname: Schultheiss
authors.forename: Carsten
authors.initials: C
authors.lastname: Tschöpe
mesh_terms: D009202:Cardiomyopathies / Q000000981:diagnostic imaging / Q000503:physiopathology; D003971:Diastole / Q000502:physiology*; D015150:Echocardiography, Doppler; D015444:Exercise; D005260:Female; D018737:Hand Strength; D054144:Heart Failure, Diastolic / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D012146:Rest; D013318:Stroke Volume / Q000502:physiology*; D013599:Systole / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016277:Ventricular Function, Left / Q000502:physiology