Different characteristics of heart failure due to pump failure and bradyarrhythmia.
BACKGROUND
Heart failure (HF) can be caused by left ventricular (LV) pump failure as well as by bradyarrhythmias. Hemodynamic differences between HF by LV pump failure and that by bradyarrhythmia have not been fully investigated. We hypothesized that HF by LV pump failure could be associated with both reduced cardiac output (CO) and increased LV filling pressure due to associated LV diastolic dysfunction, whereas HF by bradyarrhythmia could be associated with reduced CO but only modestly increased LV filling pressure due to the absence of LV diastolic dysfunction.


METHODS
In 39 patients with HF by LV pump failure (LV ejection fraction <35%), 24 with HF by bradyarrhythmia, and 22 normal controls, LV volume, ejection fraction, stroke volume, left atrial volume, and early diastolic mitral valve flow to tissue annular velocity ratio (E/E') were measured by echocardiography.


RESULTS
Compared to patients with HF by LV pump failure, those with HF by bradyarrhythmia had significantly lower heart rates, less LV dilatation, preserved LV ejection fraction, preserved stroke volume, similarly reduced cardiac index (1.8 ± 0.4 vs. 1.6 ± 0.4 L/min/m(2), n.s.), preserved LV diastolic function (E') (4.4 ± 2.1 vs. 7.1 ± 2.9 cm/s, p < 0.001), less dilated end-systolic LA volume, and preserved E/E' (24 ± 10 vs. 13 ± 7, p < 0.001).


CONCLUSIONS
HF by LV pump failure is characterized by both significantly reduced CO and increased LV filling pressure, whereas HF by bradyarrhythmia is characterized by a similar reduction in CO but only modestly increased LV filling pressure.
Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555 Japan.
Mai
M
Iwataki
Echocardiography Laboratory, Asan Medical Center, Seoul, Korea.
Yun-Jeong
YJ
Kim
Echocardiography Laboratory, Asan Medical Center, Seoul, Korea.
Byung-Joo
BJ
Sun
Echocardiography Laboratory, Asan Medical Center, Seoul, Korea.
Jeong-Yoon
JY
Jang
Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555 Japan.
Masaaki
M
Takeuchi
Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555 Japan.
Shota
S
Fukuda
Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555 Japan.
Kyoko
K
Otani
Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555 Japan.
Hidetoshi
H
Yoshitani
Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555 Japan.
Hisaharu
H
Ohe
Department of Heart Rhythm Management, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan.
Ritsuko
R
Kohno
Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555 Japan.
Yasushi
Y
Oginosawa
Department of Heart Rhythm Management, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan.
Haruhiko
H
Abe
Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Boston, MA USA.
Robert A
RA
Levine
Echocardiography Laboratory, Asan Medical Center, Seoul, Korea.
Jae-Kwan
JK
Song
Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555 Japan.
Yutaka
Y
Otsuji
D000368:Aged; D000369:Aged, 80 and over; D001919:Bradycardia / Q000150:complications* / Q000000981:diagnostic imaging; D002302:Cardiac Output; D003971:Diastole; D015150:Echocardiography, Doppler; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000000981:diagnostic imaging; D017725:Ventricular Pressure
Bradyarrhythmia; Echocardiography; Heart failure; Left ventricular pump failure