Ventricular-vascular dynamics in pediatric patients with heart failure and preserved ejection fraction

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• 作者：Satoshi Masutani ; Seiko Kuwata ; Clara Kurishima ; Yoichi Iwamoto ; Hirofumi Saiki ; Masaya Sugimoto ; Hirotaka Ishido ; Hideaki Senzaki ; ^{hsenzaki@saitama-med.ac.jp" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Stiffness ; Ventricular-arterial coupling ; Reserve ; Dobutamine ; Coronary
• 刊名：International Journal of Cardiology
• 出版年：2016
• 出版时间：15 December 2016
• 年：2016
• 卷：225
• 期：Complete
• 页码：306-312
• 全文大小：692 K

文摘

The details of the ventricular-vascular dynamics of heart failure with preserved ejection fraction (HFpEF) in children remain poorly understood. We tested the hypothesis that pediatric HFpEF patients have ventricular systolic, diastolic, and arterial stiffening at rest as well as impaired reserve function associated with coronary supply/demand imbalance.

Methods

We studied the ventricular pressure-area relationship in 22 pediatric HFpEF patients and 22 control subjects before and after dobutamine infusion and during abdominal compression. Coronary supply/demand balance was assessed by subendocardial viability ratio (SEVR) calculated from the aortic pressure waveform.

Results

Compared with controls, the HFpEF patients had significantly higher end-systolic (Ees) and arterial (Ea) elastance. Increased ventricular diastolic stiffness also occurred in the HFpEF patients, resulting in modest elevation of end-diastolic pressure (EDP) at rest (13.6 ± 4.3 vs. 7.3 ± 2.3 mm Hg, P < 0.0001). The difference in EDP became more evident with a preload increase through abdominal compression, indicating a limited diastolic reserve in HFpEF patients (EDP changes; 11.3 ± 6.2 for HFpEF vs. 3.4 ± 0.6 mm Hg for controls, P = 0.016). The HFpEF patients exhibited impaired beta-adrenergic reserve in ventricular contractility and ventricular-arterial coupling in response to dobutamine infusion. SEVR was significantly lower in the HFpEF (0.64 ± 0.11) than in the control (0.79 ± 0.07, P < 0.0001) and was significantly correlated with LV diastolic stiffness and dobutamine-induced changes in ventricular contractility.

Conclusions

HFpEF in children involves higher ventricular-arterial stiffness at rest as well as impaired systolic and diastolic reserve, which closely correlate with impaired coronary supply/demand balance.