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Heart Failure Reviews

, Volume 14, Issue 2, pp 125–134 | Cite as

Diastolic dysfunction in exercise and its role for exercise capacity

  • A. Barmeyer
  • K. Müllerleile
  • K. Mortensen
  • T. Meinertz
Article

Abstract

Diastolic dysfunction is frequent in elderly subjects and in patients with left ventricular hypertrophy, vascular disease and diabetes mellitus. Patients with diastolic dysfunction demonstrate a reduced exercise capacity and might suffer from congestive heart failure (CHF). Presence of symptoms of CHF in the setting of a normal systolic function is referred to as heart failure with normal ejection fraction (HFNEF) or, if evidence of an impaired diastolic function is observed, as diastolic heart failure (DHF). Reduced exercise capacity in diastolic dysfunction results from a number of pathophysiological alterations such as slowed myocardial relaxation, reduced myocardial distensibility, elevated filling pressures, and reduced ventricular suction forces. These alterations limit the increase of ventricular diastolic filling and cardiac output during exercise and lead to pulmonary congestion. In healthy subjects, exercise training can enhance diastolic function and exercise capacity and prevent deterioration of diastolic function in the course of aging. In patients with diastolic dysfunction, exercise capacity can be enhanced by exercise training and pharmacological treatment, whereas improvement of diastolic function can only be observed in few patients.

Keywords

Diastolic dysfunction Diastolic heart failure Exercise capacity 

References

  1. 1.
    Senni M, Tribouilloy CM, Rodeheffer RJ et al (1998) Congestive heart failure in the community: a study of all incident cases in Olmsted County, Minnesota, in 1991. Circulation 98(21):2282–2289PubMedGoogle Scholar
  2. 2.
    European Study Group on Diastolic Heart Failure (1998) How to diagnose diastolic heart failure. Eur Heart J 19(7):990–1003. doi: 10.1053/euhj.1998.1057 CrossRefGoogle Scholar
  3. 3.
    Salmasi AM, Frost P, Dancy M (2004) Impaired left ventricular diastolic function during isometric exercise in asymptomatic patients with hyperlipidaemia. Int J Cardiol 95(2–3):275–280. doi: 10.1016/j.ijcard.2003.06.005 PubMedCrossRefGoogle Scholar
  4. 4.
    Jermendy G, Khoor S, Koltai MZ et al (1990) Left ventricular diastolic dysfunction in type 1 (insulin-dependent) diabetic patients during dynamic exercise. Cardiology 77(1):9–16PubMedCrossRefGoogle Scholar
  5. 5.
    Zile MR, Gaasch WH, Carroll JD et al (2001) Heart failure with a normal ejection fraction: is measurement of diastolic function necessary to make the diagnosis of diastolic heart failure? Circulation 104(7):779–782. doi: 10.1161/hc3201.094226 PubMedCrossRefGoogle Scholar
  6. 6.
    Zile MR, Baicu CF, Gaasch WH (2004) Diastolic heart failure—abnormalities in active relaxation and passive stiffness of the left ventricle. N Engl J Med 350(19):1953–1959. doi: 10.1056/NEJMoa032566 PubMedCrossRefGoogle Scholar
  7. 7.
    Zile MR, Brutsaert DL (2002) New concepts in diastolic dysfunction and diastolic heart failure: Part I: diagnosis, prognosis, and measurements of diastolic function. Circulation 105(11):1387–1393. doi: 10.1161/hc1102.105289 PubMedCrossRefGoogle Scholar
  8. 8.
    Galderisi M (2005) Diastolic dysfunction and diastolic heart failure: diagnostic, prognostic and therapeutic aspects. Cardiovasc Ultrasound 3:9. doi: 10.1186/1476-7120-3-9 PubMedCrossRefGoogle Scholar
  9. 9.
    Paulus WJ, Tschope C, Sanderson JE et al (2007) How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology. Eur Heart J 28(20):2539–2550. doi: 10.1093/eurheartj/ehm037 PubMedCrossRefGoogle Scholar
  10. 10.
    Hirota Y (1980) A clinical study of left ventricular relaxation. Circulation 62(4):756–763PubMedGoogle Scholar
  11. 11.
    Yamakado T, Takagi E, Okubo S et al (1997) Effects of aging on left ventricular relaxation in humans. Analysis of left ventricular isovolumic pressure decay. Circulation 95(4):917–923PubMedGoogle Scholar
  12. 12.
    Little WC, Downes TR (1990) Clinical evaluation of left ventricular diastolic performance. Prog Cardiovasc Dis 32(4):273–290. doi: 10.1016/0033-0620(90)90017-V PubMedCrossRefGoogle Scholar
  13. 13.
    Cohen GI, Pietrolungo JF, Thomas JD et al (1996) A practical guide to assessment of ventricular diastolic function using Doppler echocardiography. J Am Coll Cardiol 27(7):1753–1760. doi: 10.1016/0735-1097(96)00088-5 PubMedCrossRefGoogle Scholar
  14. 14.
    Moller JE, Sondergaard E, Poulsen SH et al (2000) Pseudonormal and restrictive filling patterns predict left ventricular dilation and cardiac death after a first myocardial infarction: a serial color M-mode Doppler echocardiographic study. J Am Coll Cardiol 36(6):1841–1846. doi: 10.1016/S0735-1097(00)00965-7 PubMedCrossRefGoogle Scholar
  15. 15.
    Ommen SR, Nishimura RA, Appleton CP et al (2000) Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: a comparative simultaneous Doppler-catheterization study. Circulation 102(15):1788–1794PubMedGoogle Scholar
  16. 16.
    Lubien E, DeMaria A, Krishnaswamy P et al (2002) Utility of B-natriuretic peptide in detecting diastolic dysfunction: comparison with Doppler velocity recordings. Circulation 105(5):595–601. doi: 10.1161/hc0502.103010 PubMedCrossRefGoogle Scholar
  17. 17.
    Dudek D, Rzeszutko L, Petkow Dimitrow P et al (2001) Circulating N-terminal brain natriuretic peptide precursor and endothelin levels in patients with syndrome X and left bundle branch block with preserved systolic function. Int J Cardiol 79(1):25–30. doi: 10.1016/S0167-5273(01)00400-4 PubMedCrossRefGoogle Scholar
  18. 18.
    Ando T, Ogawa K, Yamaki K et al (1996) Plasma concentrations of atrial, brain, and C-type natriuretic peptides and endothelin-1 in patients with chronic respiratory diseases. Chest 110(2):462–468. doi: 10.1378/chest.110.2.462 PubMedCrossRefGoogle Scholar
  19. 19.
    Tulevski II, Hirsch A, Sanson BJ et al (2001) Increased brain natriuretic peptide as a marker for right ventricular dysfunction in acute pulmonary embolism. Thromb Haemost 86(5):1193–1196PubMedGoogle Scholar
  20. 20.
    Tsutamoto T, Wada A, Sakai H et al (2006) Relationship between renal function and plasma brain natriuretic peptide in patients with heart failure. J Am Coll Cardiol 47(3):582–586. doi: 10.1016/j.jacc.2005.10.038 PubMedCrossRefGoogle Scholar
  21. 21.
    Jones AE, Kline JA (2003) Elevated brain natriuretic peptide in septic patients without heart failure. Ann Emerg Med 42(5):714–715. doi: 10.1016/S0196-0644(03)00622-X PubMedCrossRefGoogle Scholar
  22. 22.
    Bevegard S, Holmgren A, Jonsson B (1963) Circulatory studies in well trained athletes at rest and during heavy exercise. With special reference to stroke volume and the influence of body position. Acta Physiologica Scandinavica 57:26–50PubMedCrossRefGoogle Scholar
  23. 23.
    Mc Ardle WD, Katch FI, Katch VL (1994) Essentials of exercise physiology. Lea Febiger, Philadelphia, pp 257–259Google Scholar
  24. 24.
    Gledhill N, Cox D, Jamnik R (1994) Endurance athletes’ stroke volume does not plateau: major advantage is diastolic function. Med Sci Sports Exerc 26(9):1116–1121. doi: 10.1249/00005768-199409000-00008 PubMedGoogle Scholar
  25. 25.
    Janssen PM, Periasamy M (2007) Determinants of frequency-dependent contraction and relaxation of mammalian myocardium. J Mol Cell Cardiol 43(5):523–531. doi: 10.1016/j.yjmcc.2007.08.012 PubMedCrossRefGoogle Scholar
  26. 26.
    Tate CA, Taffet GE, Hudson EK et al (1990) Enhanced calcium uptake of cardiac sarcoplasmic reticulum in exercise-trained old rats. Am J Physiol 258(2 Pt 2):H431–H435Google Scholar
  27. 27.
    Notomi Y, Popovic ZB, Yamada H et al (2007) Ventricular untwisting: a temporal link between left ventricular relaxation and suction. Am J Physiol: Heart Circ Physiol (Nov):21Google Scholar
  28. 28.
    Cheng CP, Igarashi Y, Little WC (1992) Mechanism of augmented rate of left ventricular filling during exercise. Circ Res 70(1):9–19PubMedGoogle Scholar
  29. 29.
    Yellin EL, Nicolic SD, Frater RWM (1994) Diastolic suction and the dynamics of left ventricular filling. In: Gassch WH, LeWinter MM (eds) Left ventricular diastolic dysfunction and heart failure. Lea Febiger, Philadelphia, pp 89–102Google Scholar
  30. 30.
    Tavli T, Cin VG, Tavli V et al (1995) The use of the handgrip maneuver to identify left ventricular diastolic function abnormalities by Doppler echocardiography in patients with coronary artery disease. Jpn Heart J 36(1):23–28PubMedGoogle Scholar
  31. 31.
    Pu M (1991) Influence of isometric exercise on left ventricular diastolic function in the normal subjects and in patients with hypertension and coronary heart disease. Zhonghua Xin Xue Guan Bing Za Zhi 19(5):311–313, 332Google Scholar
  32. 32.
    Borgia MC, Pellicelli AM, Medici F et al (1998) Left ventricular filling in young patients affected by insulin-dependent diabetes mellitus: a stress Doppler echocardiographic study. Panminerva Med 40(3):204–209PubMedGoogle Scholar
  33. 33.
    Tarumi N, Iwasaka T, Takahashi N et al (1993) Left ventricular diastolic filling properties in diabetic patients during isometric exercise. Cardiology 83(5–6):316–323PubMedCrossRefGoogle Scholar
  34. 34.
    Nair VM, Tekin UN, Khan IA et al (2000) Worsening of left ventricular diastolic dysfunction during exercise causes decreased exercise tolerance in hypertension. Clin Cardiol 23(9):660–664PubMedCrossRefGoogle Scholar
  35. 35.
    Rovner A, Greenberg NL, Thomas JD et al (2005) Relationship of diastolic intraventricular pressure gradients and aerobic capacity in patients with diastolic heart failure. Am J Physiol: Heart Circ Physiol 289(5):H2081–H2088. doi: 10.1152/ajpheart.00951.2004 Google Scholar
  36. 36.
    Ha JW, Oh JK, Pellikka PA et al (2005) Diastolic stress echocardiography: a novel noninvasive diagnostic test for diastolic dysfunction using supine bicycle exercise Doppler echocardiography. J Am Soc Echocardiogr 18(1):63–68. doi: 10.1016/j.echo.2004.08.033 PubMedCrossRefGoogle Scholar
  37. 37.
    Tschope C, Kasner M, Westermann D et al (2005) Elevated NT-ProBNP levels in patients with increased left ventricular filling pressure during exercise despite preserved systolic function. J Card Fail 11(5, Suppl):S28–S33. doi: 10.1016/j.cardfail.2005.04.013 Google Scholar
  38. 38.
    Fukuta H, Little WC (2007) Elevated left ventricular filling pressure after maximal exercise predicts increased plasma B-type natriuretic peptide levels in patients with impaired relaxation pattern of diastolic filling. J Am Soc Echocardiogr 20(7):832–837. doi: 10.1016/j.echo.2007.01.004 PubMedCrossRefGoogle Scholar
  39. 39.
    Mottram PM, Haluska BA, Marwick TH (2004) Response of B-type natriuretic peptide to exercise in hypertensive patients with suspected diastolic heart failure: correlation with cardiac function, hemodynamics, and workload. Am Heart J 148(2):365–370. doi: 10.1016/j.ahj.2004.02.012 PubMedCrossRefGoogle Scholar
  40. 40.
    Kotchen TA, Hartley LH, Rice TW et al (1971) Renin, norepinephrine, and epinephrine responses to graded exercise. J Appl Physiol 31(2):178–184PubMedGoogle Scholar
  41. 41.
    Wade CE, Claybaugh JR (1980) Plasma renin activity, vasopressin concentration, and urinary excretory responses to exercise in men. J Appl Physiol 49(6):930–936PubMedGoogle Scholar
  42. 42.
    Convertino VA, Keil LC, Greenleaf JE (1983) Plasma volume, renin, and vasopressin responses to graded exercise after training. J Appl Physiol 54(2):508–514PubMedGoogle Scholar
  43. 43.
    Cheng CP, Suzuki M, Ohte N et al (1996) Altered ventricular and myocyte response to angiotensin II in pacing-induced heart failure. Circ Res 78(5):880–892PubMedGoogle Scholar
  44. 44.
    Alexopoulos D, Machac J, Arora RR et al (1989) Exercise-induced pulmonary blood volume changes and diastolic dysfunction of the aged heart. Clin Cardiol 12(4):209–213PubMedGoogle Scholar
  45. 45.
    Galderisi M, Cicala S, De Simone L et al (2001) Impact of myocardial diastolic dysfunction on coronary flow reserve in hypertensive patients with left ventricular hypertrophy. Italian Heart J 2(9):677–684Google Scholar
  46. 46.
    Arruda AL, Pellikka PA, Olson TP et al (2007) Exercise capacity, breathing pattern, and gas exchange during exercise for patients with isolated diastolic dysfunction. J Am Soc Echocardiogr 20(7):838–846. doi: 10.1016/j.echo.2006.12.006 PubMedCrossRefGoogle Scholar
  47. 47.
    Lavietes MH, Gerula CM, Fless KG et al (2004) Inspiratory muscle weakness in diastolic dysfunction. Chest 126(3):838–844. doi: 10.1378/chest.126.3.838 PubMedCrossRefGoogle Scholar
  48. 48.
    Reduto LA, Wickemeyer WJ, Young JB et al (1981) Left ventricular diastolic performance at rest and during exercise in patients with coronary artery disease. Assessment with first-pass radionuclide angiography. Circulation 63(6):1228–1237PubMedGoogle Scholar
  49. 49.
    Manolas J (1990) Value of the handgrip apex cardiography test for detection of early diastolic ventricular dysfunction in patients with angina pectoris. Zeitschrift fur Kardiologie 79(12):825–830Google Scholar
  50. 50.
    Sakamoto K, Nakamura T, Zen K et al (2004) Identification of exercise-induced left ventricular systolic and diastolic dysfunction using gated SPECT in patients with coronary artery disease. J Nucl Cardiol 11(2):152–158. doi: 10.1016/j.nuclcard.2003.12.007 PubMedCrossRefGoogle Scholar
  51. 51.
    Barnes E, Baker CS, Dutka DP et al (2000) Prolonged left ventricular dysfunction occurs in patients with coronary artery disease after both dobutamine and exercise induced myocardial ischaemia. Heart (British Cardiac Society) 83(3):283–289. doi: 10.1136/heart.83.3.283 Google Scholar
  52. 52.
    Paul AK, Kusuoka H, Hasegawa S et al (2002) Prolonged diastolic dysfunction following exercise induced ischaemia: a gated myocardial perfusion SPECT study. Nucl Med Commun 23(11):1129–1136. doi: 10.1097/00006231-200211000-00014 PubMedCrossRefGoogle Scholar
  53. 53.
    Fragasso G, Benti R, Sciammarella M et al (1991) Symptom-limited exercise testing causes sustained diastolic dysfunction in patients with coronary disease and low effort tolerance. J Am Coll Cardiol 17(6):1251–1255PubMedCrossRefGoogle Scholar
  54. 54.
    Guazzi M, Brenner DA, Apstein CS et al (2001) Exercise intolerance in rats with hypertensive heart disease is associated with impaired diastolic relaxation. Hypertension 37(2):204–208PubMedGoogle Scholar
  55. 55.
    Poirier P, Garneau C, Bogaty P et al (2000) Impact of left ventricular diastolic dysfunction on maximal treadmill performance in normotensive subjects with well-controlled type 2 diabetes mellitus. Am J Cardiol 85(4):473–477. doi: 10.1016/S0002-9149(99)00774-2 PubMedCrossRefGoogle Scholar
  56. 56.
    Dekleva M, Celic V, Kostic N et al (2007) Left ventricular diastolic dysfunction is related to oxidative stress and exercise capacity in hypertensive patients with preserved systolic function. Cardiology 108(1):62–70. doi: 10.1159/000095883 PubMedCrossRefGoogle Scholar
  57. 57.
    Dumont CA, Monserrat L, Peteiro J et al (2007) Relation of left ventricular chamber stiffness at rest to exercise capacity in hypertrophic cardiomyopathy. Am J Cardiol 99(10):1454–1457. doi: 10.1016/j.amjcard.2006.12.077 PubMedCrossRefGoogle Scholar
  58. 58.
    Spinelli L, Petretta M, Verderame G et al (2003) Left ventricular diastolic function and cardiac performance during exercise in patients with acromegaly. J Clin Endocrinol Metab 88(9):4105–4109. doi: 10.1210/jc.2003-030462 PubMedCrossRefGoogle Scholar
  59. 59.
    Brubaker PH, Marburger CT, Morgan TM et al (2003) Exercise responses of elderly patients with diastolic versus systolic heart failure. Med Sci Sports Exerc 35(9):1477–1485. doi: 10.1249/01.MSS.0000084416.71232.EA PubMedCrossRefGoogle Scholar
  60. 60.
    Borlaug BA, Melenovsky V, Russell SD et al (2006) Impaired chronotropic and vasodilator reserves limit exercise capacity in patients with heart failure and a preserved ejection fraction. Circulation 114(20):2138–2147. doi: 10.1161/CIRCULATIONAHA.106.632745 PubMedCrossRefGoogle Scholar
  61. 61.
    Witte KK, Nikitin NP, Cleland JG et al (2006) Excessive breathlessness in patients with diastolic heart failure. Heart (British Cardiac Society) 92(10):1425–1429. doi: 10.1136/hrt.2005.081521 Google Scholar
  62. 62.
    Hundley WG, Kitzman DW, Morgan TM et al (2001) Cardiac cycle-dependent changes in aortic distensibility are reduced in older patients with isolated diastolic heart failure and correlate with exercise intolerance. J Am Coll Cardiol 38(3):796–802. doi: 10.1016/S0735-1097(01)01447-4 PubMedCrossRefGoogle Scholar
  63. 63.
    Kitzman DW, Little WC, Brubaker PH et al (2002) Pathophysiological characterization of isolated diastolic heart failure in comparison to systolic heart failure. J Am Med Assoc 288(17):2144–2150. doi: 10.1001/jama.288.17.2144 CrossRefGoogle Scholar
  64. 64.
    Yuasa F, Sumimoto T, Takeuchi M et al (1995) Effects of left ventricular diastolic dysfunction on exercise capacity three to six weeks after acute myocardial infarction in men. Am J Cardiol 75(1):14–17. doi: 10.1016/S0002-9149(99)80518-9 PubMedCrossRefGoogle Scholar
  65. 65.
    Skaluba SJ, Litwin SE (2004) Mechanisms of exercise intolerance: insights from tissue Doppler imaging. Circulation 109(8):972–977. doi: 10.1161/01.CIR.0000117405.74491.D2 PubMedCrossRefGoogle Scholar
  66. 66.
    Terzi S, Sayar N, Bilsel T et al (2007) Tissue Doppler imaging adds incremental value in predicting exercise capacity in patients with congestive heart failure. Heart Vessels 22(4):237–244. doi: 10.1007/s00380-006-0961-x PubMedCrossRefGoogle Scholar
  67. 67.
    Eroglu S, Yildirir A, Bozbas H et al (2007) Brain natriuretic peptide levels and cardiac functional capacity in patients with dyspnea and isolated diastolic dysfunction. Int Heart J 48(1):97–106. doi: 10.1536/ihj.48.97 PubMedCrossRefGoogle Scholar
  68. 68.
    Wang YC, Hwang JJ, Lai LP et al (2007) Coexistence and exercise exacerbation of intraleft ventricular contractile dyssynchrony in hypertensive patients with diastolic heart failure. Am Heart J 154(2):278–284. doi: 10.1016/j.ahj.2007.04.008 PubMedCrossRefGoogle Scholar
  69. 69.
    Brandao MU, Wajngarten M, Rondon E et al (1993) Left ventricular function during dynamic exercise in untrained and moderately trained subjects. J Appl Physiol 75(5):1989–1995PubMedGoogle Scholar
  70. 70.
    Levy WC, Cerqueira MD, Abrass IB et al (1993) Endurance exercise training augments diastolic filling at rest and during exercise in healthy young and older men. Circulation 88(1):116–126PubMedGoogle Scholar
  71. 71.
    Nixon JV, Wright AR, Porter TR et al (1991) Effects of exercise on left ventricular diastolic performance in trained athletes. Am J Cardiol 68(9):945–949. doi: 10.1016/0002-9149(91)90414-G PubMedCrossRefGoogle Scholar
  72. 72.
    Douglas PS, O’Toole ML, Hiller WD et al (1986) Left ventricular structure and function by echocardiography in ultraendurance athletes. Am J Cardiol 58(9):805–809. doi: 10.1016/0002-9149(86)90358-9 PubMedCrossRefGoogle Scholar
  73. 73.
    Di Bello V, Santoro G, Talarico L et al (1996) Left ventricular function during exercise in athletes and in sedentary men. Med Sci Sports Exerc 28(2):190–196. doi: 10.1097/00005768-199602000-00006 PubMedGoogle Scholar
  74. 74.
    Matsuda M, Sugishita Y, Koseki S et al (1983) Effect of exercise on left ventricular diastolic filling in athletes and nonathletes. J Appl Physiol 55(2):323–328PubMedGoogle Scholar
  75. 75.
    Forman DE, Manning WJ, Hauser R et al (1992) Enhanced left ventricular diastolic filling associated with long-term endurance training. J Gerontol 47(2):M56–M58PubMedGoogle Scholar
  76. 76.
    Takemoto KA, Bernstein L, Lopez JF et al (1992) Abnormalities of diastolic filling of the left ventricle associated with aging are less pronounced in exercise-trained individuals. Am Heart J 124(1):143–148. doi: 10.1016/0002-8703(92)90932-L PubMedCrossRefGoogle Scholar
  77. 77.
    Yu CM, Li LS, Lam MF et al (2004) Effect of a cardiac rehabilitation program on left ventricular diastolic function and its relationship to exercise capacity in patients with coronary heart disease: experience from a randomized, controlled study. Am Heart J 147(5):e24. doi: 10.1016/j.ahj.2003.12.004
  78. 78.
    Loimaala A, Groundstroem K, Rinne M et al (2007) Exercise training does not improve myocardial diastolic tissue velocities in Type 2 diabetes. Cardiovasc Ultrasound 5:32. doi: 10.1186/1476-7120-5-32 PubMedCrossRefGoogle Scholar
  79. 79.
    Smart N, Haluska B, Jeffriess L et al (2007) Exercise training in systolic and diastolic dysfunction: effects on cardiac function, functional capacity, and quality of life. Am Heart J 153(4):530–536. doi: 10.1016/j.ahj.2007.01.004 PubMedCrossRefGoogle Scholar
  80. 80.
    Brassard P, Legault S, Garneau C et al (2007) Normalization of diastolic dysfunction in type 2 diabetics after exercise training. Med Sci Sports Exerc 39(11):1896–1901PubMedCrossRefGoogle Scholar
  81. 81.
    Warner JG Jr, Metzger DC, Kitzman DW et al (1999) Losartan improves exercise tolerance in patients with diastolic dysfunction and a hypertensive response to exercise. J Am Coll Cardiol 33(6):1567–1572. doi: 10.1016/S0735-1097(99)00048-0 PubMedCrossRefGoogle Scholar
  82. 82.
    Little WC, Wesley-Farrington DJ, Hoyle J et al (2004) Effect of candesartan and verapamil on exercise tolerance in diastolic dysfunction. J Cardiovasc Pharmacol 43(2):288–293. doi: 10.1097/00005344-200402000-00019 PubMedCrossRefGoogle Scholar
  83. 83.
    Little WC, Zile MR, Klein A et al (2006) Effect of losartan and hydrochlorothiazide on exercise tolerance in exertional hypertension and left ventricular diastolic dysfunction. Am J Cardiol 98(3):383–385. doi: 10.1016/j.amjcard.2006.01.106 PubMedCrossRefGoogle Scholar
  84. 84.
    Aldigier JC, Huang H, Dalmay F et al (1993) Angiotensin-converting enzyme inhibition does not suppress plasma angiotensin II increase during exercise in humans. J Cardiovasc Pharmacol 21(2):289–295PubMedGoogle Scholar
  85. 85.
    Yip GW, Wang M, Wang T et al (2008) The Hong Kong diastolic heart failure study: a randomized control trial of diuretics, Irbesartan and Ramipril on quality of life, exercise capacity, left ventricular global and regional function in heart failure with a normal ejection fraction. Heart (British Cardiac Society) (Jan):20Google Scholar
  86. 86.
    Kapuku GK, Seto S, Mori H et al (1993) Reversal of diastolic dysfunction in borderline hypertension by long-term medical treatment. Longitudinal evaluation by pulsed Doppler echocardiography. Am J Hypertens 6(7 Pt 1):547–553Google Scholar
  87. 87.
    Roongsritong C, Sutthiwan P, Bradley J et al (2005) Spironolactone improves diastolic function in the elderly. Clin Cardiol 28(10):484–487. doi: 10.1002/clc.4960281008 PubMedCrossRefGoogle Scholar
  88. 88.
    Mottram PM, Haluska B, Leano R et al (2004) Effect of aldosterone antagonism on myocardial dysfunction in hypertensive patients with diastolic heart failure. Circulation 110(5):558–565. doi: 10.1161/01.CIR.0000138680.89536.A9 PubMedCrossRefGoogle Scholar
  89. 89.
    Nodari S, Metra M, Dei Cas L (2003) Beta-blocker treatment of patients with diastolic heart failure and arterial hypertension. A prospective, randomized, comparison of the long-term effects of atenolol vs. nebivolol. Eur J Heart Fail 5(5):621–627. doi: 10.1016/S1388-9842(03)00054-0 Google Scholar
  90. 90.
    Fletcher BJ, Balady GJ, Amsterdam EA et al (2001) Exercise standards for testing and training: a statement for healthcare professionals from the American Heart Association. Circulation 104(14):1694–1740. doi: 10.1161/hc3901.095960 PubMedCrossRefGoogle Scholar
  91. 91.
    Pina IL, Apstein CS, Balady GJ et al (2003) Exercise and heart failure: a statement from the American Heart Association Committee on exercise, rehabilitation, and prevention. Circulation 107(4):1210–1225. doi: 10.1161/01.CIR.0000055013.92097.40 PubMedCrossRefGoogle Scholar
  92. 92.
    Williams MA, Haskell WL, Ades PA et al (2007) Resistance exercise in individuals with and without cardiovascular disease: 2007 update: a scientific statement from the American Heart Association Council on Clinical Cardiology and Council on Nutrition, Physical Activity, and Metabolism. Circulation 116(5):572–584. doi: 10.1161/CIRCULATIONAHA.107.185214 PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • A. Barmeyer
    • 1
  • K. Müllerleile
    • 1
  • K. Mortensen
    • 1
  • T. Meinertz
    • 1
  1. 1.Department of Cardiology/Angiology, Center for Cardiology and Cardiovascular SurgeryUniversity Hospital Hamburg-EppendorfHamburgGermany

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