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Stratification of impaired relaxation filling patterns by passive leg lifting in patients with preserved left ventricular ejection fraction
Author(s) -
Ishizu Tomoko,
Seo Yoshihiro,
Kawano Satoru,
Watanabe Shigeyuki,
Ishimitsu Toshiyuki,
Aonuma Kazutaka
Publication year - 2008
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1016/j.ejheart.2008.07.011
Subject(s) - cardiology , medicine , preload , ventricle , ejection fraction , diastole , heart failure with preserved ejection fraction , heart failure , hemodynamics , blood pressure
Methods: We evaluated diastolic functional reserve in 108 patients with normal left ventricular ejection fraction (LVEF) ≥ 50% but abnormal relaxation (ratio of transmitral peak velocity of early and late diastolic flow (E/A)<1) using passive leg lifting. We calculated the pulmonary venous systolic to diastolic flow ratio (S/D) as a marker of left atrial reservoir function, and the time difference between the duration of pulmonary venous retrograde flow (PVAd) and the duration of the mitral A wave (PVAd‐Ad) as a marker of left ventricular end‐diastolic pressure (LVEDP). Results: During leg lifting, the E/A was ≥ 1 in 39 patients (the inverted group); the remaining 69 patients comprised the stable group. Comparing the inverted group with the stable group at baseline, S/D was smaller (1.5±0.4 vs. 1.8±0.5, P =0.002) and PVAd‐Ad greater (11±23 ms vs. −23±28 ms, P <0.001).Multiple logistic regression analysis revealed that PVAd‐Ad and S/D predicted E/A inversion with leg lifting after adjustment for age, LV wall thickness, LV dimension, LVEF, deceleration time of E, and E/E'. Conclusion: In patients with preserved LVEF but early diastolic dysfunction, passive leg lifting may identify patients having a less compliant left ventricle and impaired left atrial reservoir function.