Coexistence and exercise exacerbation of intraleft ventricular contractile dyssynchrony in hypertensive patients with diastolic heart failure

Yi Chih Wang, Juey Jen Hwang, Ling Ping Lai, Chia Ti Tsai, Lung Chun Lin, Rodolphe Katra, Jiunn Lee Lin

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Background: Patients with heart failure (HF) and a normal left ventricular ejection fraction usually present with diastolic dysfunction (DD). Whether intraleft ventricular contractile dyssynchrony (IVCD) coexists with DD and contributes to the clinical manifestations of HF remains unclear. The study investigated the IVCD at rest and after exercise in hypertensive patients with diastolic HF (DHF). Methods: Echocardiography was performed in 60 hypertensive patients with narrow QRS, left ventricular ejection fraction ≥50%, and no active ischemia. Patients were grouped as having DD (mitral E/A <1 plus E deceleration time >200 milliseconds, or mitral annular early diastolic velocity <8 cm/s; n = 26), DD plus HF symptoms/signs (DHF, n = 13), or as non-DD (n = 21). Results: At rest, the IVCD index (SD of 12 left ventricular segmental electromechanical delays) was greater in the DHF and DD groups than that in the non-DD group (52.2 ± 10.7 and 39.1 ± 23.6 vs 23.1 ± 19.9 milliseconds; P < .05 for both comparisons). Six-minute treadmill exercise induced exacerbation of dyssynchrony in the DHF group (67.0 ± 12.9 vs 52.2 ± 10.7 milliseconds; P < .001). Multivariate analysis revealed that the combination of IVCD index ≥35 milliseconds at rest and ≥50 milliseconds after exercise was independently associated with DHF (odds ratio = 20, 95% CI = 2-199, P = .009). Postexercise IVCD index correlated positively with plasma N-terminal pro-brain natriuretic peptide (r = 0.37, P = .004). Conclusions: Exercise would aggravate intraventricular dyssynchrony in hypertensive patients with DHF, implicating a potential contribution of systolic dyssynchrony to clinical manifestations.

Original languageEnglish
Pages (from-to)278-284
Number of pages7
JournalAmerican Heart Journal
Volume154
Issue number2
DOIs
Publication statusPublished - Aug 1 2007
Externally publishedYes

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Diastolic Heart Failure
Exercise
Heart Failure
Stroke Volume
Brain Natriuretic Peptide
Signs and Symptoms
Echocardiography
Multivariate Analysis
Ischemia
Odds Ratio

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Coexistence and exercise exacerbation of intraleft ventricular contractile dyssynchrony in hypertensive patients with diastolic heart failure. / Wang, Yi Chih; Hwang, Juey Jen; Lai, Ling Ping; Tsai, Chia Ti; Lin, Lung Chun; Katra, Rodolphe; Lin, Jiunn Lee.

In: American Heart Journal, Vol. 154, No. 2, 01.08.2007, p. 278-284.

Research output: Contribution to journalArticle

Wang, Yi Chih ; Hwang, Juey Jen ; Lai, Ling Ping ; Tsai, Chia Ti ; Lin, Lung Chun ; Katra, Rodolphe ; Lin, Jiunn Lee. / Coexistence and exercise exacerbation of intraleft ventricular contractile dyssynchrony in hypertensive patients with diastolic heart failure. In: American Heart Journal. 2007 ; Vol. 154, No. 2. pp. 278-284.
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abstract = "Background: Patients with heart failure (HF) and a normal left ventricular ejection fraction usually present with diastolic dysfunction (DD). Whether intraleft ventricular contractile dyssynchrony (IVCD) coexists with DD and contributes to the clinical manifestations of HF remains unclear. The study investigated the IVCD at rest and after exercise in hypertensive patients with diastolic HF (DHF). Methods: Echocardiography was performed in 60 hypertensive patients with narrow QRS, left ventricular ejection fraction ≥50{\%}, and no active ischemia. Patients were grouped as having DD (mitral E/A <1 plus E deceleration time >200 milliseconds, or mitral annular early diastolic velocity <8 cm/s; n = 26), DD plus HF symptoms/signs (DHF, n = 13), or as non-DD (n = 21). Results: At rest, the IVCD index (SD of 12 left ventricular segmental electromechanical delays) was greater in the DHF and DD groups than that in the non-DD group (52.2 ± 10.7 and 39.1 ± 23.6 vs 23.1 ± 19.9 milliseconds; P < .05 for both comparisons). Six-minute treadmill exercise induced exacerbation of dyssynchrony in the DHF group (67.0 ± 12.9 vs 52.2 ± 10.7 milliseconds; P < .001). Multivariate analysis revealed that the combination of IVCD index ≥35 milliseconds at rest and ≥50 milliseconds after exercise was independently associated with DHF (odds ratio = 20, 95{\%} CI = 2-199, P = .009). Postexercise IVCD index correlated positively with plasma N-terminal pro-brain natriuretic peptide (r = 0.37, P = .004). Conclusions: Exercise would aggravate intraventricular dyssynchrony in hypertensive patients with DHF, implicating a potential contribution of systolic dyssynchrony to clinical manifestations.",
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T1 - Coexistence and exercise exacerbation of intraleft ventricular contractile dyssynchrony in hypertensive patients with diastolic heart failure

AU - Wang, Yi Chih

AU - Hwang, Juey Jen

AU - Lai, Ling Ping

AU - Tsai, Chia Ti

AU - Lin, Lung Chun

AU - Katra, Rodolphe

AU - Lin, Jiunn Lee

PY - 2007/8/1

Y1 - 2007/8/1

N2 - Background: Patients with heart failure (HF) and a normal left ventricular ejection fraction usually present with diastolic dysfunction (DD). Whether intraleft ventricular contractile dyssynchrony (IVCD) coexists with DD and contributes to the clinical manifestations of HF remains unclear. The study investigated the IVCD at rest and after exercise in hypertensive patients with diastolic HF (DHF). Methods: Echocardiography was performed in 60 hypertensive patients with narrow QRS, left ventricular ejection fraction ≥50%, and no active ischemia. Patients were grouped as having DD (mitral E/A <1 plus E deceleration time >200 milliseconds, or mitral annular early diastolic velocity <8 cm/s; n = 26), DD plus HF symptoms/signs (DHF, n = 13), or as non-DD (n = 21). Results: At rest, the IVCD index (SD of 12 left ventricular segmental electromechanical delays) was greater in the DHF and DD groups than that in the non-DD group (52.2 ± 10.7 and 39.1 ± 23.6 vs 23.1 ± 19.9 milliseconds; P < .05 for both comparisons). Six-minute treadmill exercise induced exacerbation of dyssynchrony in the DHF group (67.0 ± 12.9 vs 52.2 ± 10.7 milliseconds; P < .001). Multivariate analysis revealed that the combination of IVCD index ≥35 milliseconds at rest and ≥50 milliseconds after exercise was independently associated with DHF (odds ratio = 20, 95% CI = 2-199, P = .009). Postexercise IVCD index correlated positively with plasma N-terminal pro-brain natriuretic peptide (r = 0.37, P = .004). Conclusions: Exercise would aggravate intraventricular dyssynchrony in hypertensive patients with DHF, implicating a potential contribution of systolic dyssynchrony to clinical manifestations.

AB - Background: Patients with heart failure (HF) and a normal left ventricular ejection fraction usually present with diastolic dysfunction (DD). Whether intraleft ventricular contractile dyssynchrony (IVCD) coexists with DD and contributes to the clinical manifestations of HF remains unclear. The study investigated the IVCD at rest and after exercise in hypertensive patients with diastolic HF (DHF). Methods: Echocardiography was performed in 60 hypertensive patients with narrow QRS, left ventricular ejection fraction ≥50%, and no active ischemia. Patients were grouped as having DD (mitral E/A <1 plus E deceleration time >200 milliseconds, or mitral annular early diastolic velocity <8 cm/s; n = 26), DD plus HF symptoms/signs (DHF, n = 13), or as non-DD (n = 21). Results: At rest, the IVCD index (SD of 12 left ventricular segmental electromechanical delays) was greater in the DHF and DD groups than that in the non-DD group (52.2 ± 10.7 and 39.1 ± 23.6 vs 23.1 ± 19.9 milliseconds; P < .05 for both comparisons). Six-minute treadmill exercise induced exacerbation of dyssynchrony in the DHF group (67.0 ± 12.9 vs 52.2 ± 10.7 milliseconds; P < .001). Multivariate analysis revealed that the combination of IVCD index ≥35 milliseconds at rest and ≥50 milliseconds after exercise was independently associated with DHF (odds ratio = 20, 95% CI = 2-199, P = .009). Postexercise IVCD index correlated positively with plasma N-terminal pro-brain natriuretic peptide (r = 0.37, P = .004). Conclusions: Exercise would aggravate intraventricular dyssynchrony in hypertensive patients with DHF, implicating a potential contribution of systolic dyssynchrony to clinical manifestations.

KW - diastolic heart failure

KW - disease exacerbation

KW - echocardiography

KW - heart left ventricle ejection fraction

KW - heart ventricle arrhythmia

KW - hypertension

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