title: Impact of acute hypertension transients on diastolic function in patients with heart failure with preserved ejection fraction.
abstract: OBJECTIVE
  To address the mechanisms responsible for the increase in LV filling pressures induced by acute hypertension transients in patients with heart failure with preserved ejection fraction (HFpEF).
  
  
  RESULTS
  Multiple-beat pressure-volume loops were recorded during inferior vena cava occlusion in 39 HFpEF patients and 20 controls during handgrip and atrial pacing. We measured the contribution of relaxation, elastic recoil, and stiffness to instantaneous diastolic pressure using a novel processing method. Fibrosis was quantified from endomyocardial biopsies. HFpEF patients showed higher diastolic pressures and stiffness constant than controls (P < 0.05 for all). As opposed to controls, all intrinsic global diastolic properties were sensitive to acute changes in systolic pressure in the HFpEF group. In fact, the stiffness constant increased by more than 50% during handgrip in HFpEF patients (P < 0.05), tightly related to changes in systolic pressure (fixed-effect = 0.26 mm Hg per mm Hg [95% CI = 0.15-0.37]; P < 0.0001). Incomplete relaxation contributed to increasing pressure before atrial contraction, but changes in end-diastolic pressure was mostly caused by the increase in stiffness. The degree of pressure-sensitivity of stiffness correlated with myocardial collagen volume and crosslinking (R = 0.40 to 0.82 for all).
  
  
  CONCLUSIONS
  Acute chamber stiffening is the main mechanism responsible for rising late-diastolic pressures when HFpEF patients undergo hypertension transients. This stiffening behaviour is related to impaired dynamic systolic-diastolic interactions and correlates with matrix remodelling. Ventricular-vascular relationships are a promising target in HFpEF and should be taken into account when assessing diastolic function.
authors.affiliation: Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, and CIBERCV, Dr. Esquerdo 46, 28007 Madrid, Spain.
authors.forename: Candelas
authors.initials: C
authors.lastname: Pérez Del Villar
authors.affiliation: Department of Cardiology, Barts Heart Centre, Queen Mary University of London, London EC1A 7BE, UK.|Berlin-Brandenburg Centre for Regenerative Therapies, Föhrer Str. 15, 13353 Berlin, Germany.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Savvatis
authors.affiliation: Program of Cardiovascular Diseases, Centre for Applied Medical Research, University of Navarra, IdiSNA, Navarra Institute for Health Research, and CIBERCV, Pío XII 55, 31008 Pamplona, Spain.
authors.forename: Begoña
authors.initials: B
authors.lastname: López
authors.affiliation: Department of Cardiology, Charité University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany.
authors.forename: Mario
authors.initials: M
authors.lastname: Kasner
authors.affiliation: Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, and CIBERCV, Dr. Esquerdo 46, 28007 Madrid, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Martinez-Legazpi
authors.affiliation: Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, and CIBERCV, Dr. Esquerdo 46, 28007 Madrid, Spain.
authors.forename: Raquel
authors.initials: R
authors.lastname: Yotti
authors.affiliation: Program of Cardiovascular Diseases, Centre for Applied Medical Research, University of Navarra, IdiSNA, Navarra Institute for Health Research, and CIBERCV, Pío XII 55, 31008 Pamplona, Spain.
authors.forename: Arantxa
authors.initials: A
authors.lastname: González
authors.affiliation: Program of Cardiovascular Diseases, Centre for Applied Medical Research, University of Navarra, IdiSNA, Navarra Institute for Health Research, and CIBERCV, Pío XII 55, 31008 Pamplona, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Díez
authors.affiliation: Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, and CIBERCV, Dr. Esquerdo 46, 28007 Madrid, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Fernández-Avilés
authors.affiliation: Berlin-Brandenburg Centre for Regenerative Therapies, Föhrer Str. 15, 13353 Berlin, Germany.|Department of Cardiology, Charité-University Medicine Berlin, Campus Virchow Klinikum, Augustenburger Pl. 1, 13353 Berlin, Germany.|DZHK, German Center for Cardiovascular Research, Partner Site Berlin-Charité, Oudenarder Str. 16, 13347 Berlin, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Tschöpe
authors.affiliation: Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, and CIBERCV, Dr. Esquerdo 46, 28007 Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Bermejo
mesh_terms: D000328:Adult; D000368:Aged; D003971:Diastole / Q000502:physiology*; D005260:Female; D018737:Hand Strength / Q000502:physiology; D006333:Heart Failure / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D013318:Stroke Volume / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology*
keywords: Diastolic function ; Diastolic stiffness; Heart failure ; Hypertension ; Left ventricle 