Excessive breathlessness in patients with diastolic heart failure. Issue 10 (18th April 2006)

• Record Type: Journal Article
• Authors: Witte, K K A; Nikitin, N P; Cleland, J G F; Clark, A L
• Is Part Of: Heart. Volume 92:Issue 10(2006)
• Page Start: 1425
• Page End: 1429
• Publication Date: 2006-04-18
• Subjects: CDD, controls with diastolic dysfunction -- CN, controls with normal diastolic function -- DD, diastolic dysfunction -- DHF, diastolic heart failure -- IVRT, isovolumic relaxation time -- LV, left ventricular -- NYHA, New York Heart Association -- PSF, preserved systolic function -- PSFDD, preserved systolic function and diastolic dysfunction -- PSFN, preserved systolic function without diastolic dysfunction -- pV̇o2, peak oxygen consumption -- SHF, systolic heart failure -- V̇co2, carbon dioxide production -- V̇e, minute ventilation; Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/hrt.2005.081521
• Languages: English
• ISSNs: 1355-6037

Abstract

Abstract : Objectives: To establish the prevalence of preserved left ventricular (LV) systolic function (PSF) in 435 consecutive symptomatic patients referred to a heart failure clinic and to examine their ventilatory response to exercise when compared with 134 control volunteers. Methods: 216 (50%) patients had systolic heart failure (SHF) (ejection fraction < 45%). 51 (11%) had an immediately apparent alternative causes of breathlessness and 168 (39%), with no obvious other cause of breathlessness, were divided into those with PSF and diastolic dysfunction (DD) (PSFDD ; n = 113 or 26% of referrals) and those without DD (PSFN ; n = 55 or 13% of referrals). The controls were divided into those with (CDD ; n = 32) and those without (CN ; n = 102) echocardiographic evidence of DD. Results: Patients with SHF had lower peak oxygen consumption (pV̇o 2 ), steeper slope of minute ventilation (V̇e ) to carbon dioxide production, lower exercise time and shorter 6 min walk test than PSF patients and controls. PSFDD patients had lower pV̇o 2, exercise time and 6 min walk test than CDD, although their echocardiograms were not different. Exercise capacity did not differ between PSFDD and PSFN patients. The slope relating V̇e to symptoms (Borg/V̇e slope) was less steep in those with SHF than in PSFDD (0.17 (0.04) v 0.20 (0.08), p < 0.05) and in PSFN (0.19 (0.10), p < 0.05), implying greater symptoms of breathlessness for a given level of V̇e . Both PSF groups had a steeper slope than CDD (0.14 (0.09), p < 0.05 for both comparisons). Conclusions: Patients with PSF have exercise tolerance intermediate between that of patients with SHF and controls. Exercise tolerance is similar in PSFDD and PSFN . Both groups have worse exercise tolerance than CDD . PSFDD and PSFN patients seem to experience a greater awareness of V̇e than CDD and patients with SHF.