Background: Left ventricular (LV) diastolic dysfunction is a common finding in patients with systolic heart failure (HF). Severe diastolic dysfunction, which is defined as LV restrictive filling pattern (RFP), is associated with more severe HF, increased sympathetic activity and reduced exercise capacity. It has also been shown to be a predictor of lower survival rate in patients with HF.
Aim:
To evaluate associations between LV diastolic RFP and BNP levels, systolic pulmonary pressure and exercise capacity in patients with clinically stable HF.
Methods: In 56 patients with HF and low LVEF a standard echocardiographic study and cardiopulmonary exercise test were performed. Levels of BNP using RIA method were also measured.
Results: Restrictive filling pattern (E/A >2 or 1< E/A <2 and DTE ≤130 ms) was diagnosed in 26 patients. The RFP group showed increased levels of BNP (90.6±66 vs. 50.4±61 pg/ml; p=0.003), significantly reduced peak VO₂ (15.4±4.1 vs. 17.8±4.9 ml/kg/min; p=0.046), increased VE/VCO₂ slope (36.3±5.9 vs. 31.9±6.3; p=0.01), and elevated PASP (pulmonary artery systolic pressure measured by echo-Doppler) (49.3±13.8 vs. 37.2±12.6 mmHg; p=0.02). Prevalence of pulmonary hypertension was significantly higher in the RFP group. A significant correlation between DTE and peak VO₂ (r=0.28; p=0.02) and inverse correlations between DTE and BNP levels (r=–048; p=0.003), VE/VCO₂ slope (r=–0.35; p=0.02) and PASP (r=–0.39; p=0.03) were found. In logistic regression analysis only RFP was independently associated with pulmonary hypertension.
Conclusions: The restrictive filling pattern is an independent predictor of pulmonary hypertension and is associated with increased BNP levels and worse result of cardiopulmonary exercise test.