RESTRICTIVE LEFT-VENTRICULAR FILLING PATTERNS ARE PREDICTIVE OF DIASTOLIC VENTRICULAR INTERACTION IN CHRONIC HEART-FAILURE

Objectives, The purpose of this study was to determine whether restric tive left ventricular (LV) filling patterns are associated with diasto lic ventricular interaction in patients with chronic heart failure. Ba ckground, We recently demonstrated a diastolic ventricular interaction in similar to 50% of a series of patients with chronic heart failure, as evidenced by paradoxic increases in LV end-diastolic volume despit e reductions in right ventricular end-diastolic volume during volume u nloading achieved by lower body negative pressure (LBNP), We reasoned that such an interaction would impede LV filling in mid and late diast ole, but would be minimal in early diastole, resulting in a restrictiv e LV filling pattern, Methods. Transmitral flow was assessed using pul sed wave Doppler echocardiography in 30 patients with chronic heart fa ilure and an LV ejection fraction less than or equal to 35%. Peak earl y (E) and atrial (A) filling velocities and E wave deceleration time w ere measured, Left ventricular end-diastolic volume was measured using 1 radionuclide ventriculography before and during -30-mm Hg LBNP. Con clusions. Restrictive LV filling patterns are associated with diastoli c ventricular interaction in patients with chronic heart failure, Volu me unloading in the setting of diastolic ventricular interaction allow s for increased LV filling, Identifying patients with chronic heart fa ilure and restrictive filling patterns may therefore indicate a group likely to benefit from additional vasodilator therapy. (C) 1998 by the American College of Cardiology.