Diastolic relaxation and compliance reserve during dynamic exercise in heart failure with preserved ejection fraction
Open accessAbstract
Background: Recent studies have examined haemodynamic changes with stressors such as isometric handgrip and rapid atrial pacing in heart failure with preserved ejection fraction (HFpEF), but little is known regarding left ventricular (LV) pressure–volume responses during dynamic exercise. Objective: To assess LV haemodynamic responses to dynamic exercise in patients with HFpEF. Methods: Twenty subjects with normal ejection fraction (EF) and exertional dyspnoea underwent invasive haemodynamic assessment during dynamic exercise to evaluate suspected HFpEF. Results: LV end-diastolic pressure was elevated at rest (>15 mm Hg, n=18) and with exercise (≥20 mm Hg, n=20) in all subjects, consistent with HFpEF. Heart rate (HR), blood pressure, arterial elastance and cardiac output increased with exercise (all p<0.001). Minimal and mean LV diastolic pressures increased by 43–56% with exercise (both p<0.0001), despite a trend towards a reduction in LV end-diastolic volume (p=0.08). Diastolic filling time was abbreviated with increases in HR and the proportion of diastole that elapsed prior to estimated complete relaxation increased (p<0.0001), suggesting inadequate relaxation reserve relative to the shortening of diastole. LV diastolic chamber elastance acutely increased 50% during exercise (p=0.0003). Exercise increases in LV filling pressures correlated with changes in diastolic relaxation rates, chamber stiffness and arterial afterload but were not related to alterations in preload volume, HR or cardiac output. Conclusion: In patients with newly diagnosed HFpEF, LV filling pressures increase during dynamic exercise in association with inadequate enhancement of relaxation and acute increases in LV chamber stiffness. Therapies that enhance diastolic reserve function may improve symptoms of exertional intolerance in patients with hypertensive heart disease and early HFpEF.
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The fundamental structural and functional characteristics of the HFpEF heart include delayed and incomplete LV relaxation and reduced LV compliance.
“The fundamental structural and functional characteristics of the HFpEF heart include delayed and incomplete LV relaxation and reduced LV compliance.6,7”
From Reversal of contractile defects by mediating calcium homeostasis in human mini-heart models of heart failure with preserved ejection fraction (HFpEF) leads to first-in-human gene therapy clinical trial (2024) · cites this paper as [6]
The Results (Study population and Baseline hemodynamics) report prolonged LV relaxation in 50% of subjects. The Results (LV Diastolic Reserve with exercise) and Discussion describe less complete relaxation and increased chamber stiffness during exercise. These findings support the functional abnormalities, but not the unqualified claim that delayed relaxation and reduced compliance are fundamental characteristics of every HFpEF heart. (LLM, conf=0.83)
Experimental — accuracy not yet measuredIn mammalian hearts, HFpEF is associated with impaired cardiac relaxation, or lusitropy, which is evident both at rest and during exercise in the majority of HFpEF patients.
“In mammalian hearts, HFpEF is associated with impaired cardiac relaxation, or lusitropy, which is evident both at rest and during exercise in the majority of HFpEF patients.6,44”
From Reversal of contractile defects by mediating calcium homeostasis in human mini-heart models of heart failure with preserved ejection fraction (HFpEF) leads to first-in-human gene therapy clinical trial (2024) · cites this paper as [6]
The Results (Study population and Baseline hemodynamics; page unavailable) report prolonged relaxation at rest in 50% of the 20 subjects, not a majority. The Discussion (Diastolic Relaxation Reserve; page unavailable) reports inadequate enhancement of relaxation during exercise, but does not establish that a majority had impaired relaxation both at rest and during exercise. (LLM, conf=0.88)
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- Authors
- Borlaug, B. A., Jaber, W. A., Ommen, S. R., Lam, C. S. P., Redfield, M. M., & Nishimura, R. A.
- Affiliations
- Mayo Clinic (US)
- Corresponding author
- Borlaug, Barry A
- ORCID
- Venue
- Heart
- Publisher
- BMJ
- Published
- 2011-04-08
- Volume
- 97
- Issue
- 12
- Pages
- 964-969
- ISSN
- 1355-6037 (ISSN-L)
- 1468-201X
- PMC
- PMC3767403
- OpenAlex
- W2169883086
- Cited by
- 229
- References
- 36
- Citations by year
- 2026: 11 · 2025: 8 · 2024: 11 · 2023: 14 · 2022: 11 · 2021: 15 · 2020: 23 · 2019: 18 · 2018: 17 · 2017: 15 · 2016: 18 · 2015: 20 · 2014: 19 · 2013: 11 · 2012: 9
- FWCI
- 10.12
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Heart (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (HL-84907, U01HL084907, T32HL007111)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Keywords
- heart failure with preserved ejection fraction, diastolic relaxation, left ventricular compliance, dynamic exercise, left ventricular filling pressure, left ventricular stiffness, diastolic filling time, exertional dyspnea, hypertensive heart disease
- MeSH terms
- Aged, Compliance, Diastole, Dyspnea, Female, Cardiac Catheterization, Heart Failure, Hemodynamics, Humans, Male, Middle Aged, Stroke Volume, Exercise, Ventricular Dysfunction, Left
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