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
. 2022 Jul 5;11(13):e026009.
doi: 10.1161/JAHA.121.026009. Epub 2022 Jun 29.

Diastolic Filling Time, Chronotropic Response, and Exercise Capacity in Heart Failure and Preserved Ejection Fraction With Sinus Rhythm

Kazuki Kagami  1   2 , Masaru Obokata  1 , Tomonari Harada  1 , Toshimitsu Kato  1 , Naoki Wada  3 , Takeshi Adachi  2 , Hideki Ishii  1
Affiliations

Diastolic Filling Time, Chronotropic Response, and Exercise Capacity in Heart Failure and Preserved Ejection Fraction With Sinus Rhythm

Kazuki Kagami et al. J Am Heart Assoc. .

Abstract

Background Exercise-induced high heart rate may impair exercise tolerance by reducing diastolic filling time and ventricular filling in heart failure with preserved ejection fraction (HFpEF). Given the importance of chronotropic response, we hypothesized that reduction in diastolic filling time because of exercise-induced increased heart rate would not impair cardiac output reserve and exercise capacity. We sought to determine the association between heart rate, diastolic filling time, hemodynamics, and exercise capacity in HFpEF. Methods and Results Patients with HFpEF (n=66) and controls without HF (n=107) underwent bicycle exercise echocardiography with simultaneous expired gas analysis to measure oxygen consumption. Diastolic filling time was assessed by the overlap time between mitral E- and A-waves (longer overlap time indicates shorter diastolic filling duration). Overlap time increased (ie, diastolic filling time shortened) in HFpEF and controls as heart rate increased with exercise, and the relationship was similar between the groups. Greater heart rate response correlated with higher cardiac output (r=0.51, P<0.0001) and oxygen consumption (r=0.50, P<0.0001) during peak exercise. Shorter diastolic filling time, as assessed by longer overlap time, was correlated with higher cardiac output (r=0.47, P<0.0001) and peak oxygen consumption (r=0.38, P=0.007), not with E/e' or right ventricular-pulmonary artery uncoupling. Longer overlap time was associated with mitral A velocity (r=0.53, P<0.0001) and left atrial booster pump strain (r=0.42, P<0.0001). Conclusions Shortening of diastolic filling interval in tandem with increased heart rate during exercise does not limit cardiac output reserve or exercise capacity in HFpEF.

Keywords: chronotropic incompetence; diastolic filling time; exercise; heart failure with preserved ejection fraction.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Measurements of overlap time.
A, Diastolic filling period was assessed by the overlap time between mitral E‐ and A‐waves. A longer overlap time value indicates a shorter diastolic filling duration. B, If there was no overlap, the distance between the end of the E‐wave and the beginning of the A‐wave was expressed as a negative value.
Figure 2
Figure 2. Changes in heart rate and overlap time during exercise.
A and B, Heart rate and overlap time as a function of workload in heart failure with preserved ejection fraction (HFpEF) and control subjects. C, There was a moderate correlation between heart rate and overlap time during peak exercise. D, From baseline to peak exercise, the relationship between heart rate and overlap time was similar between patients with HFpEF and control subjects. The vertical and horizontal error bars represent 95% CIs. *P<0.05 and **P<0.01 between groups for single time point comparisons. bpm indicates beats per minute.
Figure 3
Figure 3. Correlations between overlap time, cardiac output, and oxygen consumption during peak exercise.
A and B, Higher heart rate during peak exercise was correlated with higher cardiac output (CO) and better exercise capacity as assessed by peak oxygen consumption (VO2) in all participants. C and D, Similarly, longer overlap time (ie, shorter diastolic filling time) was associated with higher CO and VO2 during peak exercise even in patients with HFpEF. bpm indicates beats per minute; and HFpEF, heart failure with preserved ejection fraction.
Figure 4
Figure 4. Correlations between overlap time and left atrial function during peak exercise.
A, The overlap time was correlated with higher mitral A‐wave velocity and (B) left atrial (LA) booster pump strain during peak exercise both in patients with heart failure with preserved ejection fraction (HFpEF) and controls.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Borlaug BA. Evaluation and management of heart failure with preserved ejection fraction. Nat Rev Cardiol. 2020;17:559–573. doi: 10.1038/s41569-020-0363-2 - DOI - PubMed
    1. Obokata M, Olson TP, Reddy YNV, Melenovsky V, Kane GC, Borlaug BA. Haemodynamics, dyspnoea, and pulmonary reserve in heart failure with preserved ejection fraction. Eur Heart J. 2018;39:2810–2821. doi: 10.1093/eurheartj/ehy268 - DOI - PMC - PubMed
    1. Houstis NE, Eisman AS, Pappagianopoulos PP, Wooster L, Bailey CS, Wagner PD, Lewis GD. Exercise intolerance in heart failure with preserved ejection fraction. Circulation. 2018;137:148–161. doi: 10.1161/CIRCULATIONAHA.117.029058 - DOI - PMC - PubMed
    1. Obokata M, Reddy YNV, Borlaug BA. Diastolic dysfunction and heart failure with preserved ejection fraction: understanding mechanisms by using noninvasive methods. JACC Cardiovasc Imaging. 2020;13:245–257. doi: 10.1016/j.jcmg.2018.12.034 - DOI - PMC - PubMed
    1. Borlaug BA, Jaber WA, Ommen SR, Lam CSP, Redfield MM, Nishimura RA. Diastolic relaxation and compliance reserve during dynamic exercise in heart failure with preserved ejection fraction. Heart. 2011;97:964–969. doi: 10.1136/hrt.2010.212787 - DOI - PMC - PubMed

Publication types