Hemodynamic characteristics of patients with diastolic heart failure and hypertension

Hypertens Res. 2008 Sep;31(9):1727-35. doi: 10.1291/hypres.31.1727.

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.

Publication types

  • Clinical Trial
  • Comparative Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Blood Pressure / drug effects
  • Blood Pressure / physiology
  • Cardiac Catheterization
  • Cardiac Volume / drug effects
  • Cardiac Volume / physiology
  • Female
  • Heart Failure, Diastolic / drug therapy*
  • Heart Failure, Diastolic / physiopathology*
  • Humans
  • Hypertension / drug therapy*
  • Hypertension / physiopathology*
  • Male
  • Middle Aged
  • Nitroglycerin / administration & dosage*
  • Stroke Volume / drug effects
  • Stroke Volume / physiology
  • Vascular Resistance / drug effects
  • Vascular Resistance / physiology
  • Vasodilator Agents / administration & dosage*
  • Ventricular Function, Left / drug effects
  • Ventricular Function, Left / physiology

Substances

  • Vasodilator Agents
  • Nitroglycerin