title: Hemodynamic characteristics of patients with diastolic heart failure and hypertension.
abstract: Diastolic heart failure (DHF) has different underlying pathophysiologic mechanisms. We sought to compare hemodynamic characteristics in DHF patients with or without hypertension. A conductance catheter with microtip-manometer was used to measure left ventricular (LV) function and hemodynamics in 28 DHF patients. After baseline measurements, nitroglycerin was infused to alter the loading condition and the measurements were repeated. At baseline, end-systolic pressure was higher and the time constant of LV relaxation (tau) was longer in hypertensive DHF patients. Patients in hypertensive DHF had lower LV-arterial coupling ratio than those in non-hypertensive DHF. The peak of loading sequence was in early systole in non-hypertensive DHF patients and in late systole in hypertensive DHF patients. Nitroglycerin decreased LV end-systolic pressure and end-diastolic volume in both groups. In non-hypertensive DHF, nitroglycerin significantly reduced stroke volume and shortened tau (59+/-11 vs. 54+/-10 ms, p<0.05) without any changes in the time to peak LV force, effective arterial elastance (E(a)), or LV-arterial coupling ratio. In contrast, in hypertensive DHF patients, nitroglycerin significantly reduced E(a) and shortened the time to peak LV force, resulting in an improved LV-arterial coupling ratio, preserved stroke volume and shortened tau (75+/-14 vs. 62+/-13 ms, p<0.05). In conclusion, LV relaxation was more prolonged in hypertensive DHF patients than non-hypertensive DHF patients, partly because of the different loading sequence. Changing the loading condition by nitroglycerin improved LV systolic and diastolic function in hypertensive DHF patients.
authors.affiliation: Department of Cardiology, Mie University Graduate School of Medicine, 2-175 Edobashi, Tsu, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Fujimoto
authors.forename: Katsuya
authors.initials: K
authors.lastname: Onishi
authors.forename: Kaoru
authors.initials: K
authors.lastname: Dohi
authors.forename: Masaki
authors.initials: M
authors.lastname: Tanabe
authors.forename: Tairo
authors.initials: T
authors.lastname: Kurita
authors.forename: Takeshi
authors.initials: T
authors.lastname: Takamura
authors.forename: Norikazu
authors.initials: N
authors.lastname: Yamada
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Nobori
authors.forename: Masaaki
authors.initials: M
authors.lastname: Ito
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D006328:Cardiac Catheterization; D002306:Cardiac Volume / Q000187:drug effects / Q000502:physiology; D005260:Female; D054144:Heart Failure, Diastolic / Q000188:drug therapy* / Q000503:physiopathology*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D005996:Nitroglycerin / Q000008:administration & dosage*; D013318:Stroke Volume / Q000187:drug effects / Q000502:physiology; D014655:Vascular Resistance / Q000187:drug effects / Q000502:physiology; D014665:Vasodilator Agents / Q000008:administration & dosage*; D016277:Ventricular Function, Left / Q000187:drug effects / Q000502:physiology
chemical_list: D014665:Vasodilator Agents; D005996:Nitroglycerin