Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2011 Jul;17(7):547-55.
doi: 10.1016/j.cardfail.2011.03.010. Epub 2011 May 6.

The impact of extra cardiac comorbidities on pressure volume relations in heart failure and preserved ejection fraction

Dmitry Abramov  1 , Kun-Lun He, Jie Wang, Daniel Burkhoff, Mathew S Maurer
Affiliations
Comparative Study

The impact of extra cardiac comorbidities on pressure volume relations in heart failure and preserved ejection fraction

Dmitry Abramov et al. J Card Fail. 2011 Jul.

Abstract

Background: Extracardiac comorbidities are common in patients with heart failure and a preserved ejection fraction (HFPEF). We sought to evaluate the relationship between comorbidities and ventricular structure and function in patients with HFPEF through evaluation of pressure-volume analysis.

Methods and results: Two hundred twenty Chinese patients with a preserved ejection fraction who were either healthy (n = 75), hypertensive without heart failure (HTN; n = 89), or hypertensive with HFPEF (HFPEF; n = 56) were studied. Using echocardiographic measures, estimated end-systolic and end-diastolic pressure-volume relationships, and the area between them as a function of EDP, the isovolumic pressure-volume areas (PVA(iso)), were calculated. Ventricular capacitance, as measured by V(30), was larger in patients with HFPEF compared with normal control subjects and tended to be larger compared with hypertensive control subjects. The presence of diabetes and renal insufficiency was independently associated with greater ventricular capacitance in patients with HFPEF. The PVA(iso) was increased in patients with HFPEF compared with HTN and normal control subjects, and in particular, it was increased in HFPEF patients with multiple comorbidities.

Conclusions: The presence of comorbid conditions is associated with altered pressure-volume relations and enhanced pump function in subjects with HFPEF, supporting an important role for extracardiac comorbidities in the pathophysiology of patients with this condition.

PubMed Disclaimer

Figures

Figure 1
Figure 1
(Upper Figures) Pressure-volume analyses demonstrating the normal PV loop and the determinants of ventricular function, including the ESPVR and the EDPVR (Panel A). Shifts in the ESPVR are often equated with changes in inotropic state (Panel B), while shifts in the EDPVR toward smaller volumes or reduced capacitance (diastolic dysfunction) or toward larger volumes or increased capacitance (remodeling). The ESPVR is characterized by the slope [Ees] and the volume axis intercept [V0], which can be described collectively by the V120, the volume of the left ventricle required to generate an end systolic pressure of 120 mm Hg (Panel C). Shifts in the EDPVR can be characterized by V30, the ventricular volume at a pressure of 30 mm Hg, (Panel C). See Methods section for additional details. (Lower Figures) Demonstration of how PVAiso is calculated from the PV diagram (Panels D and E). One value for PVAiso (shaded area) can be obtained for each end-diastolic PV point shown by the black circles along the EDPVR. The points of a, b, and c in Panel D correspond to the solid line PVAiso curve in Panel E. With shifts of the ESPVR and EDPVR (not shown), the PVAiso curve can show increased or decreased cardiac function (dashed PVAiso curves), Panel E.
Figure 2
Figure 2
Estimated graphical representation of the end-diastolic pressure-volume relationships among the studied populations. Hypertensive without heart failure (HTN), heart failure with preserved ejection fraction and 0,1, and 2+ comorbidities, HFPEF-0, HFPEF-1, HFPEF-2, respectively
Figure 3
Figure 3
PVAiso relationships, demonstrating cardiac function, in patients with HTN, in normal controls, and in HFPEF with varied comorbidity burden (0,1, or 2+ comorbidities)
See this image and copyright information in PMC

References

    1. Bhatia RS, Tu JV, Lee DS, Austin PC, Fang J, Haouzi A, et al. Outcome of heart failure with preserved ejection fraction in a population-based study. N Engl J Med. 2006;355:260–9. - PubMed
    1. Fonarow GC, Stough WG, Abraham WT, Albert NM, Gheorghiade M, Greenberg BH, et al. Characteristics, treatments, and outcomes of patients with preserved systolic function hospitalized for heart failure: a report from the OPTIMIZE-HF Registry. J Am Coll Cardiol. 2007;50:768–77. - PubMed
    1. Klapholz M, Maurer M, Lowe AM, Messineo F, Meisner JS, Mitchell J, et al. Hospitalization for heart failure in the presence of a preserved left ventricular ejection fraction: results of the New York Heart Failure Registry. J Am Coll Cardiol. 2004;43:1432–8. - PubMed
    1. Owan TE, Hodge DO, Herges RM, Jacobsen SJ, Roger VL, Redfield MM. Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med. 2006;355:251–9. - PubMed
    1. Tribouilloy C, Rusinaru D, Mahjoub H, Souliere V, Levy F, Peltier M, et al. Prognosis of heart failure with preserved ejection fraction: a 5 year prospective population-based study. Eur Heart J. 2008;29:339–47. - PubMed

Publication types