Diastolic dysfunction as a cause of exercise intolerance

Heart Fail Rev. 2000 Dec;5(4):301-6. doi: 10.1023/a:1026503028065.


Tachycardia accompanying exercise shortens the duration of diastole, reducing the time available for the left ventricular (LV) filling. Thus, the LV must fill more rapidly for the stroke volume to increase (or even be maintained) during exercise. Normally, this is accomplished without requiring an excessive increase in left atrial (LA) pressure by an acceleration of LV relaxation and a fall in LV early diastolic pressure during exercise. This response is lost following the development of heart failure due to systolic dysfunction, both in experimental animals and in patients. In fact, in such situations, LV relaxation slows and LV early diastolic pressure increases due to exercise. Thus, any diastolic dysfunction present at rest in CHF during systolic dysfunction is exacerbated during exercise. Similarly, patients with primary diastolic dysfunction heart failure with preserved systolic function may not be able to augment LV filling rates without an abnormal increase in LA pressure. Thus, diastolic dysfunction may contribute to exercise intolerance, both in systolic dysfunction and primary diastolic dysfunction. Acute studies suggest that treatment with angiotensin II receptor blockers or verapamil may improve exercise tolerance in some patients with primary diastolic dysfunction.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.
  • Review

MeSH terms

  • Animals
  • Antihypertensive Agents / pharmacology
  • Diastole / drug effects
  • Diastole / physiology*
  • Dogs
  • Exercise Tolerance*
  • Heart Failure / drug therapy
  • Heart Failure / physiopathology*
  • Humans
  • Losartan / pharmacology
  • Myocardial Contraction / drug effects
  • Myocardial Contraction / physiology
  • Ventricular Function, Left / drug effects
  • Ventricular Function, Left / physiology


  • Antihypertensive Agents
  • Losartan