Restrictive left ventricular filling patterns are predictive of diastolic ventricular interaction in chronic heart failure

Objectives, The purpose of this study was to determine whether restrictive left ventricular (LV) filling patterns are associated with diastolic ventricular interaction in patients with chronic heart failure. Background, We recently demonstrated a diastolic ventricular interaction in similar to 50% of a series of patients with chronic heart failure, as evidenced by paradoxic increases in LV end-diastolic volume despite reductions in right ventricular end-diastolic volume during volume unloading achieved by lower body negative pressure (LBNP), We reasoned that such an interaction would impede LV filling in mid and late diastole, but would be minimal in early diastole, resulting in a restrictive LV filling pattern, Methods. Transmitral flow was assessed using pulsed wave Doppler echocardiography in 30 patients with chronic heart failure and an LV ejection fraction less than or equal to 35%. Peak early (E) and atrial (A) filling velocities and E wave deceleration time were measured, Left ventricular end-diastolic volume was measured using 1 radionuclide ventriculography before and during -30-mm Hg LBNP. Conclusions. Restrictive LV filling patterns are associated with diastolic ventricular interaction in patients with chronic heart failure, Volume unloading in the setting of diastolic ventricular interaction allows for increased LV filling, Identifying patients with chronic heart failure and restrictive filling patterns may therefore indicate a group likely to benefit from additional vasodilator therapy. (C) 1998 by the American College of Cardiology.