Loss of adrenergic augmentation of diastolic intra-LV pressure difference in patients with diastolic dysfunction: Evaluation by color m-mode echocardiography

Takahiro Ohara, Cassie L. Niebel, Kelley C. Stewart, John J. Charonko, Min Pu, Pavlos P. Vlachos, William C. Little

Research output: Contribution to journalArticlepeer-review

48 Scopus citations

Abstract

Objectives: The aim of this study was to evaluate the hypothesis that the adrenergic response of the intraventricular pressure difference (IVPD) is reduced in patients with preserved ejection fraction (EF) and diastolic dysfunction (DD). Background: In early diastole, there is a progressive IVPD extending from the left atrium (LA) to the left ventricular (LV) apex. In response to adrenergic stimulation, as occurs during exercise, the IVPD increases allowing rapid filling without an abnormal increase in LA pressure. Patients with heart failure with a reduced EF have impaired adrenergic augmentation of the IVPD. Methods: We studied 166 consecutive patients undergoing dobutamine stress echocardiography who had no inducible ischemia and an EF <50%, of which 21 had normal diastolic function, 14 had impaired relaxation (grade 1), 80 had pseudonormal filling (grade 2), and 51 had restrictive filling (grade 3). Color M-mode Doppler (CMMD) images of mitral inflow were obtained at rest and during low (10 μg/kg/min) and peak (20 to 40 μg/kg/min) doses of dobutamine. The total IVPD from the LA to LV apex, LA to mid-LV, and mid-LV to the LV apex were calculated using the CMMD data to integrate the Euler equation. Results: Total IVPD was not different between groups at rest. With dobutamine, the total IVPD increased by 2.20 ± 1.95 mm Hg in normal subjects and by only 0.73 ± 1.33 mm Hg, 1.84 ± 1.63 mm Hg, and 1.08 ± 1.57 mm Hg in patients with grades 1, 2, and 3 DD, respectively. This difference was due to a failure in augmentation of IVPD from the mid-LV to the LV apex, indicating reduced apical ventricular suction with DD, whereas the IVPD from the LA to the mid-LV responded similarly to dobutamine in normal subjects and those with DD. Conclusions: In patients with preserved EF, DD is associated with a reduced adrenergic augmentation of the IVPD from the mid-LV to the LV apex, reflecting less apical suction.

Original languageEnglish (US)
Pages (from-to)861-870
Number of pages10
JournalJACC: Cardiovascular Imaging
Volume5
Issue number9
DOIs
StatePublished - Sep 2012
Externally publishedYes

Keywords

  • color M-mode Doppler
  • diastolic dysfunction
  • dobutamine stress echocardiography
  • intraventricular pressure difference

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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