Transition from chronic compensated to acute decompensated heart failure: Pathophysiological insights obtained from continuous monitoring of intracardiac pressures. Circulation 2008

Background—Approximately half of all patients with chronic heart failure (HF) have a decreased ejection fraction (EF) (systolic HF [SHF]); the other half have HF with a normal EF (diastolic HF [DHF]). However, the underlying pathophysiological differences between DHF and SHF patients are incompletely defined. The purpose of this study was to use echocardiographic and implantable hemodynamic monitor data to examine the pathophysiology of chronic compensated and acute decompensated HF in SHF versus DHF patients. Methods and Results—Patients were divided into 2 subgroups: 204 had EF 50 % (SHF) and 70 had EF 50 % (DHF). DHF patients had EF of 588%, end-diastolic dimension of 5010 mm, estimated resting pulmonary artery diastolic pressure (ePAD) of 169 mm Hg, and diastolic distensibility index (ratio of ePAD to end-diastolic volume) of 0.110.06 mm Hg/mL. In contrast, SHF patients had EF of 2410%, end-diastolic dimension of 6811 mm, ePAD of 187 mm Hg, and diastolic distensibility index of 0.060.04 mm Hg/mL (P0.05 versus DHF for all variables except ePAD). In SHF and DHF patients who developed acute decompensated HF, these events were associated with a significant increase in ePAD, from 177 to 227 mm Hg (P0.05) in DHF and from 219 to 248 mm Hg (P0.05) in SHF. As a group, patients who did not have acute decompensated HF events had no significant changes in ePAD. Conclusions—Significant structural and functional differences were found between patients with SHF and those with DHF; however, elevated diastolic pressures play a pivotal role in the underlying pathophysiology of chroni