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Dynamic Starling Mechanism in Congestive Heart Failure with Normal Ejection Fraction: the Effects of Exercise Training and Aging
Author(s) -
Shibata Shigeki,
Fu Qi,
Hastings Jeff,
Prasad Anand,
Okazaki Kazunobu,
Conner Colin,
Shook Robin,
Palmer Dean,
Zhang Rong,
Levine Benjamin D.
Publication year - 2007
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.21.6.a1254-a
Subject(s) - preload , cardiology , medicine , ejection fraction , heart failure , stroke volume , diastole , blood pressure , hemodynamics
The “Dynamic Starling mechanism” reflects both ventricular and arterial compliance. It is unknown whether this mechanism is impaired in congestive heart failure with a normal ejection fraction (CHF‐nlEF) and how aging or exercise training modifies this dynamic index of ventricular‐arterial coupling. Method: Transfer function gain between beat‐to‐beat changes in pulmonary artery diastolic pressure (PA catheter, approximating left ventricular end diastolic pressure, LVEDP) and stroke volume index (Portapres, SVi=SV/BSA) at the respiratory frequency was measured in CHF‐nlEF (age:72±7, n=8), the sedentary elderly (Old, age:70±3, n=12), Masters athletes (Fit, age:68±3, n=11), and young individuals (Young, age:26±6, n=12). Eight of Old underwent one‐year exercise training. Results: Gain LVEDP‐SVi was lower in CHF‐nlEF than Old (0.26±0.14 vs. 0.42±0.21 ml/m 2 /mmHg, P<0.05), and lower in Old than both Young (1.26±0.61 ml/m 2 /mmHg, P<0.001) and Fit (1.00±0.60 ml/m 2 /mmHg, P<0.005). Gain LVEDP‐SVi tended to be higher after one year of exercise training in Old (0.38±0.07 vs. 0.51±0.26 ml/m 2 /mmHg, P=0.10). Conclusion: The “Dynamic Starling mechanism” is more impaired in CHF‐nlEF than expected from sedentary aging alone. Exercise training may prevent or restore deterioration of ventricular‐arterial coupling with aging although the effect is limited when started later in life. Supported by NSBRI and NIH.