Diastolic dysfunction and autonomic abnormalities in patients with systolic heart failure

Background: Patients with systolic heart failure (SHF) often have concomitant diastolic dysfunction (DD). SHF is associated with decreased heart rate variability (HRV), but the impact of degree of DD on HRV in SHF is unclear. Methods and results: HRV was measured in 139 patients, aged 64 ± 12 years, 74% male, LVEF 30 ± 8%. Patients had stable NYHA class II-III CHF on ACE inhibitors or ATII receptor blockers, with LVEF ≤ 40% and BNP ≥ 200 pg/ml. Subjects underwent 2-D echocardiography with Doppler assessment and 24-h Holters. Patients were categorized as having impaired relaxation (E-deceleration time > 2 SD above age-adjusted normal values (AANV), E/A ≤ 1, systolic/diastolic pulmonary vein flow ≥ 1; N = 30), pseudonormal (E-deceleration time within 2 SD of AANV, E/A = 1-2, systolic/diastolic pulmonary vein flow < 1; N = 25) or restrictive filling patterns (E-deceleration time > 2 SD below AANV or/and E/A ratio ≥ 2; N = 84) Differences were adjusted for clinical covariates using UNIANOVA, p < 0.05. HRV was reduced and BNP higher in pseudonormal patients compared to impaired relaxation, but this difference was only significant for restrictive vs. impaired filling. Differences remained significant after adjustment for covariates. Conclusion: Significantly more abnormal HRV, reflecting greater cardiac autonomic dysfunction, is associated with restrictive DD compared to impaired relaxation.