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• W2125766377 abstract "HomeCirculationVol. 119, No. 1Response to Letter Regarding Article, “Role of Left Ventricular Stiffness in Heart Failure With Normal Ejection Fraction” Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBResponse to Letter Regarding Article, “Role of Left Ventricular Stiffness in Heart Failure With Normal Ejection Fraction” Dirk Westermann, MD, Mario Kasner, MD, Frank Spillmann, MD, Alexander Riad, MD, Wolfgang Poller, MD, Matthias Pauschinger, MD, Heinz-Peter Schultheiss, MD and Carsten Tschöpe, MD Paul Steendijk, PhD Kerstin Weitmann, MSc and Wolfgang Hoffmann, MD, MPH Dirk WestermannDirk Westermann Department of Cardiology and Pneumology, Benjamin Franklin Campus, Charité University Hospital, Berlin, Germany Search for more papers by this author , Mario KasnerMario Kasner Department of Cardiology and Pneumology, Benjamin Franklin Campus, Charité University Hospital, Berlin, Germany Search for more papers by this author , Frank SpillmannFrank Spillmann Department of Cardiology and Pneumology, Benjamin Franklin Campus, Charité University Hospital, Berlin, Germany Search for more papers by this author , Alexander RiadAlexander Riad Department of Cardiology and Pneumology, Benjamin Franklin Campus, Charité University Hospital, Berlin, Germany Search for more papers by this author , Wolfgang PollerWolfgang Poller Department of Cardiology and Pneumology, Benjamin Franklin Campus, Charité University Hospital, Berlin, Germany Search for more papers by this author , Matthias PauschingerMatthias Pauschinger Department of Cardiology and Pneumology, Benjamin Franklin Campus, Charité University Hospital, Berlin, Germany Search for more papers by this author , Heinz-Peter SchultheissHeinz-Peter Schultheiss Department of Cardiology and Pneumology, Benjamin Franklin Campus, Charité University Hospital, Berlin, Germany Search for more papers by this author and Carsten TschöpeCarsten Tschöpe Department of Cardiology and Pneumology, Benjamin Franklin Campus, Charité University Hospital, Berlin, Germany Search for more papers by this author Paul SteendijkPaul Steendijk Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands Search for more papers by this author Kerstin WeitmannKerstin Weitmann Institute for Community Medicine, Ernst-Moritz-Arndt-University of Greifswald, Greifswald, Germany Search for more papers by this author and Wolfgang HoffmannWolfgang Hoffmann Institute for Community Medicine, Ernst-Moritz-Arndt-University of Greifswald, Greifswald, Germany Search for more papers by this author Originally published6 Jan 2009https://doi.org/10.1161/CIRCULATIONAHA.108.803429Circulation. 2009;119:e5We would like to thank Dr Kass for his interest in our study, which investigated hemodynamic characteristics of patients with heart failure and normal ejection fraction (HFNEF).1An important finding in our study was that with increased paced heart rates the patients in the HFNEF group showed a decrease in end-diastolic volume leading to reduced stroke volume, which limited their ability to increase cardiac output and may explain their exertional limitations. These results were in contrast to those in the control group where end-diastolic volumes and stroke volumes were maintained or even increased at faster heart rates.The comments of Dr Kass focus on the results in our control group, and he refers to previous studies that show (in contrast to ours) a decline in filling at higher heart rates in normal subjects. We feel that the difference in heart rate response between HFNEF and controls in our study is unlikely to be related to calibration problems because our methodology was carefully established and applied identically in both groups.As a possible explanation, it is known that the observed effect is dependent on pacing rate2 and on volume load3 and therefore may vary in different studies. In our control subjects, who were studied in a supine position, pacing up to 120 bpm (as reported in our article) did not cause a decrease in end-diastolic volume.Although not reported in the article because it was only tested in a subset of the patients (9 controls, 19 patients with HFNEF), during atrial pacing at 140 bpm a decrease in end-diastolic volume was indeed found in the control group (−18% versus sinus rhythm, P<0.05). However, in the HFNEF group, end-diastolic volume dropped significantly more (−44% versus sinus rhythm, P<0.05) leading to significantly lower end-diastolic volume versus the control group also at 140 bpm (P<0.05). This reflects a cardiac abnormality leading to a more pronounced decrease in stroke volume in HFNEF patients compared with controls, which is in line with previous research from other groups.4We fully agree with Dr Kass and the editorial comments of Dr Kitzman,5 that the pathophysiology of HFNEF needs further study, and therefore we are looking forward to the results from studies like the Restoration of Chronotropic Competence in Heart Failure Patients With Normal Ejection Fraction (RESET) trial which investigates whether or not atrial pacing could be an appropriate option for HFNEF patients and whether also patients which are characterized by increased left ventricular stiffness will have a benefit from increasing heart rate.Source of FundingThis study was supported by the Deutsche Forschungsgesellschaft (SFB-TR-19, A2, B5, and Z2).DisclosuresNone. References 1 Westermann D, Kasner M, Steendijk P, Spillmann F, Riad A, Weitmann K, Hoffmann W, Poller W, Pauschinger M, Schultheiss HP, Tschope C. Role of left ventricular stiffness in heart failure with normal ejection fraction. Circulation. 2008; 117: 2051–2060.LinkGoogle Scholar2 Hasenfuss G, Holubarsch C, Hermann HP, Astheimer K, Pieske B, Just H. Influence of the force-frequency relationship on haemodynamics and left ventricular function in patients with non-failing hearts and in patients with dilated cardiomyopathy. Eur Heart J. 1994; 15: 164–170.CrossrefMedlineGoogle Scholar3 Schaefer S, Taylor AL, Lee HR, Niggemann EH, Levine BD, Popma JJ, Mitchell JH, Hillis LD. Effect of increasing heart rate on left ventricular performance in patients with normal cardiac function. Am J Cardiol. 1988; 61: 617–620.CrossrefMedlineGoogle Scholar4 Sohn DW, Kim HK, Park JS, Chang HJ, Kim YJ, Zo ZH, Oh BH, Park YB, Choi YS. Hemodynamic effects of tachycardia in patients with relaxation abnormality: abnormal stroke volume response as an overlooked mechanism of dyspnea associated with tachycardia in diastolic heart failure. J Am Soc Echocardiogr. 2007; 20: 171–176.CrossrefMedlineGoogle Scholar5 Kitzman DW. Diastolic dysfunction: one piece of the heart failure with normal ejection fraction puzzle. Circulation. 2008; 117: 2044–2046.LinkGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Hutyra M, Skala T, Kaminek M, Horak D, Kocher M, Tudos Z, Jarkovsky J, Precek J and Taborsky M (2013) Speckle tracking echocardiography derived systolic longitudinal strain is better than rest single photon emission tomography perfusion imaging for nonviable myocardium identification, Biomedical Papers, 10.5507/bp.2012.072, 157:1, (12-21), Online publication date: 1-Mar-2013. January 6, 2009Vol 119, Issue 1 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.108.803429 Originally publishedJanuary 6, 2009 PDF download Advertisement SubjectsCongenital Heart DiseaseContractile FunctionExercise Testing" @default.
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