Left atrial role in left ventricular filling at rest during exercise and during the development of heart failure

The left ventricle fills early in diastole when left ventricular pressure f alls below left atrial pressure and late in diastole when atrial contractio n raises left atrial pressure above left ventricular pressure. Early fillin g deceleration time is determined by the left ventricular early diastolic s tiffness. Rapid, early tilling deceleration indicates a stiff left ventricl e. During exercise, left ventricular filling rate is enhanced by more rapid left ventricular relaxation and lower early diastolic left ventricular pre ssures. This effect is lost after the development of heart failure. In hear t failure, exercise increases left ventricular early diastolic pressure. Th us, left ventricular filling depends on an abnormal increase in left atrial pressure.