慢性心力衰竭的左心室舒张功能检测

目的探讨舒张性心力衰竭(心衰)与收缩性心衰的超声特点。方法选择舒张性心衰患者40例为舒张性心衰组,并选择基本情况与之匹配的收缩性心衰患者40例为收缩性心衰组。应用多普勒技术进行舒张功能的检测,进而评价2组在心房、心室容积,二尖瓣口血流舒张早期流速(E)与二尖瓣口血流舒张晚期流速(A)及其比值(E/A)和E峰减速时间,二尖瓣环舒张早期峰值速度(e)和二尖瓣环舒张晚期峰值速度(a)及其比值(e/a),左心房反流入肺静脉血流速度,P波终末电势等方面的差异。结果舒张性心衰组与收缩性心衰组比较,E/A、e/a倒置。舒张性心衰组E峰减速时间延长,左心房反流入肺静脉血流速度增宽。舒张性心衰组左心房增大,左心室舒张末径正常。P波终末电势负值增大。结论肺静脉血流频谱和二尖瓣环组织多普勒可作为二尖瓣血流频谱重要补充。     

Long-term,dose-dependent effects of spironolactone on left ventricular function and exercise tolerance in patients with chronic heart failure

OBJECTIVES: This study was designed to assess the effects of spironolactone (SP) on left ventricular (LV) function and exercise tolerance in patients with chronic heart failure (CHF). BACKGROUND: In severe heart failure (HF), SP improves survival, but the underlying mechanisms are not clear. METHODS: We randomized 106 outpatients with HF to SP (12.5 to 50 mg/day) (group 1) or control (group 2). Complete echocardiography and cardiopulmonary exercise testing were performed at baseline and 12 months after randomization. RESULTS: Left ventricular end-systolic volume at baseline and at follow-up was 188 +/- 94 ml and 171 +/- 97 ml in group 1 and 173 +/- 71 ml and 168 +/- 79 ml in group 2 (treatment group-by-time interaction, p = 0.03). Left ventricular ejection fraction at baseline and at follow-up was 33 +/- 7% and 36 +/- 9% in group 1 and 34 +/- 7% and 34 +/- 9% in group 2 (treatment group-by-time interaction, p = 0.02). At baseline, 9 patients in group 1 and 3 patients in group 2 had a restrictive mitral filling pattern, a marker of severe diastolic dysfunction; at follow-up, 3 patients in group 1 and no patient in group 2 improved their pattern. No patient in group 1 and 4 patients in group 2 worsened their pattern (chi-square, p = 0.02). Peak oxygen consumption increased significantly in patients treated with 50 mg of SP and decreased in group 2 (17.7 +/- 5.2 vs. 18.5 +/- 5.9 and 19.1 +/- 5.6 vs. 17.9 +/- 5.3, respectively; analysis of variance, p = 0.01). CONCLUSIONS: Spironolactone improves LV volumes and function; furthermore, it improves exercise tolerance at the highest administered dose. Our data might explain the mortality reduction during aldosterone antagonism in patients with HF.     

The effect of resistance training on left ventricular function and structure of patients with chronic heart failure

INTRODUCTION: Resistance training (RT) has been shown to improve chronic heart failure (CHF) patients' functional ability and quality of life. Despite these benefits RT has not always been recommend as a form of exercise principally because of a concern for acceleration of the left ventricular (LV) remodeling process. This study investigated the effects of 8 weeks RT on the LV structure and function of patients with CHF. METHOD: Fifteen men who suffered from CHF were divided into either a RT program or non-training control group. Before and after 8 weeks of training patients underwent resting echocardiography to assess their end-diastolic and end-systolic dimensions (EDD and ESD, respectively), ejection fraction (EF), fractional shortening (FS) and stroke volume (SV). RESULTS: A repeated measured ANOVA showed that 8 weeks of RT had no significant effect on the LV measurements (group x time, p>0.05). Post training comparison, however, revealed that the EF and FS of the training group was significantly higher than in the control group (40.9+/-10.5% vs. 30.3+/-4.6%, p=0.029 and 25.0+/-7.0% vs. 17.4+/-3.1%, p=0.020 respectively). CONCLUSION: RT is a suitable method of training for CHF patients since it does not cause a reduction of LV contractility function or enhance myocardial deterioration as measured by EF and FS.     

Acute and chronic effects of oral hydralazine on left ventricular pump function and renal hemodynamics in chronic left heart failure

To test the acute and chronic, effects, of oral hydralazine(HD) on left ventricular (LV) pump function and renal hemodynamics,we administered it to patients with chronic left heart failure.After 6 days of HD- therapy (n = 12), there was a striking increasein cardiac index (P < 0.001) averaging 50% of control, whichwas fully maintained over a 6 month, period of chronic HD-therapy(n = 6, P < 0.001). Improvement in pump function was associatedwith a marked, chronically sustained fall in systemic vascularresistance (–43% after 6 days, P < 0.001, –40%after 6 months, P < 0.01). Despite the significant increasein cardiac index, renal perfusion did not change acutely underHD. After 6 months, however, a 32% increase in renal perfusionwas found accompanying the persistent improvement in cardiacperformance (P < 0.01). Our data suggest that oral HD is equally effective during acuteand chronic application in patients with left heart failure.After short-term HD therapy, no increase in renal perfusionoccurs, perhaps due to renal vasoconstriction involving, therenin-angiotensin system. Chronically, however, HD improvesrenal perfusion, as it controls heart failure.     

左室射血分数与老年慢性心力衰竭患者认知功能的关系

目的 探索左室射血分数与老年慢性心力衰竭患者认知功能的关系。方法 人选左室射血分数小于45%且年龄大于或等于60岁的住院慢性心衰患者共222例。使用简易智能量表(Mini-Mental State Examination,MMSE) 进行认知功能评估。收集相关临床资料。采用logistic回归分析校正混杂因素的影响。结果 以 MMSE评分<24分作为认知功能障碍的界值,46.4%(103/222)的患者存在认知功能障碍。多因素分析结果显示,在以年龄、受教育情况、长期饮酒史、伴发糖尿病史校正后,左心室射血分数减低可以增加心衰患者认知功能障碍的风险(OR=0.92,95%CI：0.87~0.97)。结论 慢性心衰患者认知障碍发生率较高,左室射血分数减低是慢性心衰患者发生认知功能障碍的独立危险因素。     

The effect of micronutrient supplementation on quality-of-life and left ventricular function in elderly patients with chronic heart failure.

AIMS: Chronic heart failure (CHF) is a common and leading cause of death in industrialized countries. The potential benefits of micronutrient supplementation in CHF are extensive. Therefore, we examined the influence of long-term multiple micronutrient supplementation on left ventricular (LV) function, levels of pro-inflammatory cytokines, and quality-of-life (QoL) in elderly patients with CHF. METHODS AND RESULTS: Thirty CHF patients [age 75.4 (0.7), mean (SEM), LV ejection fraction (LVEF) < or =35%] were randomized to receive capsules containing a combination of high-dose micronutrients (calcium, magnesium, zinc, copper, selenium, vitamin A, thiamine, riboflavin, vitamin B(6), folate, vitamin B(12), vitamin C, vitamin E, vitamin D, and Coenzyme Q10) or placebo for 9 months in a double-blind fashion. All subjects were on stable optimal medical therapy for at least 3 months before enrolment. At randomization and at study end, tumour necrosis factor-alpha and its soluble receptors TNFR-1 and TNFR-2 were measured and six-minute walk test and QoL were assessed. Cardiac magnetic resonance scanning was performed to evaluate cardiac dimensions and LVEF. Two patients died during follow-up. The remaining patients (14 randomized to placebo and 14 to micronutrients) were well matched for LV function, symptoms, and exercise capacity. At the end of the follow-up period, LV volumes were reduced in the intervention group with no change in the placebo group [-13.1 (17.1)% vs. +3.8 (10.0)%; P<0.05]. LVEF increased by 5.3+/-1.4% in the intervention group and was unchanged in the placebo group (P<0.05). Patients taking micronutrients also had a significant improvement in QoL score between enrolment and study end [+9.5 (1.6)%; P<0.05], whereas those taking placebo had a slight deterioration [-1.1 (0.8)%; P=0.12]. Six-minute walk test and inflammatory cytokine levels remained unchanged in both groups. CONCLUSION: Long-term multiple micronutrient supplementation can improve LV volumes and LVEF and QoL scores in elderly patients with heart failure due to LV systolic dysfunction.     

Effects of torasemide on left ventricular function and neurohumoral factors in patients with chronic heart failure.

The effect of torasemide and furosemide therapy was compared in 50 patients who had chronic heart failure and symptoms [NYHA class II-III] despite long-term therapy with both low-dose furosemide and angiotensin-converting enzyme inhibitors. In this randomized 6-month, open-label trial, baseline and follow-up echocardiograms and neurohumoral assays were obtained in 25 group F patients (continued same dose of oral furosemide at 20-40 mg/day) and in 25 group T patients (received torasemide at 4-8 mg/day in place of furosemide). At 6 months, parameters were unchanged in group F whereas the group T patients had a lower left ventricular end-diastolic diameter (p<0.005) and left ventricular mass index (p<0.005) with improved Doppler filling parameters, decreased plasma B-type natriuretic concentration (p<0.001) and increased plasma concentrations of active renin (p<0.005) and aldosterone (p<0.001). The magnitude of these changes appeared dose dependent and it is suggested these favorable effects of switching from furosemide to torasemide may be related to aldosterone receptor blockade.     

卡维地洛对慢性心力衰竭患者左心功能的影响

目的观察卡维地洛对慢性充血性心力衰竭患者左心室收缩功能的影响。方法117例慢性心力衰竭患者分为卡维地洛组和对照组,用心脏超声诊断仪测量治疗前和治疗后1个月、3个月的心脏结构及功能。结果两组患者治疗1个月后左心室舒张末径、左心室舒张末容积、左心室收缩末容积,左心室射血分数与治疗前比较差异均无统计学意义(P>0.05);3个月及6个月时的上述指标与治疗前比较差异均有统计学意义(P<0.05)。结论卡维地洛可明显改善慢性心力衰竭左心室收缩功能。     

Effects of levosimendan on markers of left ventricular diastolic function and neurohormonal activation in patients with advanced heart failure

In this randomized, placebo-controlled study, it was found that a 24-hour levosimendan infusion improves echocardiographic markers of abnormal left ventricular diastolic function (transmitral flow patterns and mitral annulus velocities, as assessed by transthoracic pulse-wave Doppler and tissue Doppler imaging, respectively) and reduces substances of excessive neurohormonal activation (plasma B-type natriuretic peptide and interleukin-6) in patients with advanced heart failure. Moreover, levosimendan-treated patients had fewer events and longer progression-free survival during a 5-month follow-up compared with those who received placebo. Thus, levosimendan seems to be effective in improving left ventricular diastolic function and reducing neurohormonal activation in patients with severe heart failure.     

Effect of nebivolol on left ventricular function in patients with chronic heart failure: a pilot study

BACKGROUND: Sympathetic activity is a significant predictor of a poor prognosis in heart failure. Beta-blockers have been shown to improve the prognosis of patients with heart failure. AIM: This pilot study examined the tolerability and efficacy of the new beta-blocker nebivolol on left ventricular function in patients with chronic heart failure. METHODS AND RESULTS: Twelve patients with an ejection fraction of 13-39% were included in this double blind, placebo-controlled randomized trial of nebivolol administered in addition to standard therapy. Exercise time, heart rate, left ventricular function and tolerability were examined at baseline and after 3 months of orally administered nebivolol (2.5 and 5 mg, n = 6) or placebo (n = 6). Nebivolol was well tolerated and the NYHA class improved in four patients. Heart rate decreased while the maximal exercise duration and performance remained stable. Left ventricular function increased (ejection fraction 31.5 +/- 10.11 to 42.0 +/- 10.99%, P < or = 0.01) after 12 weeks of nebivolol. The left ventricular end-systolic diameter decreased in the nebivolol-group from 56.5 +/- 9.40 to 50.2 +/- 9.43 mm (P < or = 0.02). CONCLUSION: These data indicate that nebivolol might improve cardiac function in patients with reduced left ventricular function.     

慢性心力衰竭患者左右心室收缩同步性研究

目的 :观察慢性心力衰竭 (CHF)患者左右心室收缩同步性差异 ,心电图、左室几何形态、左室收缩功能的变化。探讨双室收缩差异的发生率、双室收缩不同步与左室收缩功能、左心室几何构型、二尖瓣反流的关系。方法 :选择 2 2例CHF患者 (CHF组 ) ,NYHA分级Ⅱ～Ⅲ级 ,均符合Framingham心力衰竭诊断标准 ;健康体检者 (对照组 ) 16例 ,进行心电图、超声心动图测量、平衡状放射性核素心室造影检查。获得QRS间期、P R间期、左心室几何构型收缩期及舒张期参数 (Gibson’s指数、Cole’s指数、面积长度指数 )、二尖瓣反流程度、左和右心室功能参数、全心室的相角程、半高宽。结果 :与对照组相比CHF患者的心电图 (均P <0 .0 5 )、心脏几何构型 (均P <0 .0 5 )、左室射血分数 (LVEF)明显不同 (P <0 .0 1)、位相分析参数 (P <0 .0 1)存在着明显异常 ;77%CHF患者存在着室间非同步收缩 ,这些患者具有较低的LVEF及较重的二尖瓣反流程度 ;室间非同步收缩与左心功能呈明显负相关(r =- 0 .5 5 ,P <0 .0 5 ) ,与二尖瓣反流程度呈明显正相关 (r =0 .5 6 8,P <0 .0 5 ) ,与左心室舒张期几何形态有一定的相关性 (r =0 .5 32 ,P <0 .0 5、r =0 .5 32 ,P <0 .0 5 )。结论 :室间非同步收缩的形成与左心室舒张期几何形态及二尖瓣反流的     

Clinical outcome of patients with heart failure and preserved left ventricular function

Background

Patients with heart failure have a poor prognosis. However, it has been presumed that patients with heart failure and preserved left ventricular function (LVF) may have a more benign prognosis.

Objectives

We evaluated the clinical outcome of patients with heart failure and preserved LVF compared with patients with reduced function and the factors affecting prognosis.

Methods

We prospectively evaluated 289 consecutive patients hospitalized with a definite clinical diagnosis of heart failure based on typical symptoms and signs. They were divided into 2 subsets based on echocardiographic LVF. Patients were followed clinically for a period of 1 year.

Results

Echocardiography showed that more than one third (36%) of the patients had preserved systolic LVF. These patients were more likely to be older and female and have less ischemic heart disease. The survival at 1 year in this group was poor and not significantly different from patients with reduced LVF (75% vs 71%, respectively). The adjusted survival by Cox regression analysis was not significantly different (P = .25). However, patients with preserved LVF had fewer rehospitalizations for heart failure (25% vs 35%, P < .05). Predictors of mortality in the whole group by multivariate analysis were age, diabetes, chronic renal failure, atrial fibrillation, residence in a nursing home, and serum sodium ≤ 135 mEq/L.

Conclusion

The prognosis of patients with clinical heart failure with or without preserved LVF is poor. Better treatment modalities are needed in both subsets.     

Metoprolol CR/XL improves systolic and diastolic left ventricular function in patients with chronic heart failure

AIMS: To investigate whether metoprolol controlled release/extended release (CR/XL) once daily would improve diastolic and systolic left ventricular function in patients with chronic heart failure and decreased ejection fraction. METHODS: In an echocardiographic substudy to the Metoprolol CR/XL Randomized Intervention Trial in Heart Failure (MERIT-HF), 66 patients were examined three times during a 12-month period blinded to treatment group, assessing left ventricular dimensions and ejection fraction, and Doppler mitral inflow parameters, all measured in a core laboratory. RESULTS: In the metoprolol CR/XL group left ventricular ejection fraction increased from 0.26 to 0.31 (P = 0.009) after a mean observation period of 10.6 months, and deceleration time of the early mitral filling wave (E) increased from 189 to 246 ms (P = 0.0012), time velocity integral of E-wave increased from 8.7 to 11.2 cm (P = 0.018), and the duration of the late mitral filling wave (A) increased from 122 to 145 ms (P = 0.014). No significant changes were seen in the placebo group regarding any of these variables. CONCLUSION: Metoprolol CR/XL once daily in addition to standard therapy improved both diastolic and systolic function in patients with chronic heart failure and decreased ejection fraction.     

Acute hemodynamic effects of biventricular and left ventricular pacing in chronic pacemaker-dependent patients with advanced heart failure

The beneficial hemodynamic effects of cardiac resynchronization in patients with intraventricular conduction delay have been demonstrated. The potential hemodynamic effects of cardiac resynchronization to compensate the pacing-induced left ventricular conduction delay in chronically paced heart failure patients are not as well established. The aim of the study was to evaluate the acute hemodynamic effects of biventricular and left ventricular pacing in chronically paced patients with advanced heart failure.Fourteen consecutive pacemaker or defibrillator patients with permanent atrial fibrillation and AV block (11 male, 3 woman, mean age: 68 +/- 7 years) were enrolled in this study. There were 5 ischemic (36%) and 9 nonischemic (64%) patients (mean left ventricular ejection fraction: 19 +/- 5%; mean end-diastolic left ventricular diameter: 71 +/- 11 mm). In all patients a right ventricular and left ventricular (via coronary sinus) pacing lead was placed. The aortic and left ventricular hemodynamic measurements were performed using a two-channel micro-tip catheter. The measurements of the aortic pulse pressure (APP) and (dP/ dtmax) were performed during right ventricular apical pacing (RVP), left ventricular (LVP), and biventricular pacing (BVP) (70 bpm).Compared to RVP, LVP and BVP increased APP and dP/dtmax (35.8 +/- 4.2 vs 43.3 +/- 4.5 and 41.2 +/- 4 mmHg; p < 0.001) and (758 +/- 56 vs 967 +/- 60 and 961 +/- 62 mmHg/s; p < 0.001). LVP and BVP showed a comparable hemodynamic response. The hemodynamic effects were not related to the width of the paced QRS complex. Every patient showed improved hemodynamics during LVP and BVP unrelated to the underlying heart disease and to the baseline level of left ventricular dysfunction. BVP and LVP pacing acutely improve contractile left ventricular function in chronically paced patients with advanced heart failure.     

比索洛尔联用贝那普利对慢性心力衰竭患者左室重构和心功能的影响

目的 评价比索洛尔与贝那普利治疗慢性充血性心力衰竭（CHF）的临床疗效.方法 将285例CHF患者随机分为3组（均给予常规强心、利尿、扩血管治疗）：比索洛尔治疗组102例,贝那普利治疗组75例,比索洛尔与贝那普利组108例,观察三组治疗前后SBP、DBP、心率（HR）、左心室收缩末内径（LVESd）、左心室舒张末内径（LVEDd）及左心室射血分数（LVEF）的变化.结果 联合治疗组显效率和总有效率（75.3%和96.8%）均高于比索洛尔组（59.3%和82.7%,P＜0.05）和贝那普利组（61.1%和81.9%,P＜0.05）,无效率（3.2%）显著低于比索洛尔组（17.3%,P＜0.01）和贝那普利组（18.1%,P＜0.01）.治疗前后三组患者HR、SBP及DBP均有改善（P＜0.05）,联合治疗组较另外两组改善更明显（P＜0.01）.治疗前后三组LVEDd、LVESd及LVEF均显著改善（P＜0.05）,联合治疗组较另外两组改善明显.结论 比索洛尔治疗CHF的临床疗效与贝那普利相当,两者联合应用与单独使用相比,前者不仅能更好地提高疗效,而且安全有效.     

Comparison of left ventricular-biventricular pacing on ventricular synchrony, mitral regurgitation, and global left ventricular function in patients with severe chronic heart failure

We compared the effects of left ventricular and biventricular pacing in 16 patients (15 men and 1 woman; aged 64 +/- 8 years) with severe heart failure by conventional and tissue Doppler echocardiography. Intraventricular synchrony, regional and global systolic function, diastolic function and filling time, and the severity of secondary mitral regurgitation were similar between left ventricular and biventricular pacing.     

Prognosis in patients with heart failure and preserved left ventricular systolic function.

BACKGROUND: It is recognized that heart failure patients with preserved left ventricular systolic function have better prognosis; nevertheless, there are some studies with conflicting results. Also, there is a paucity of data concerning the prognostic factors in this group of patients. OBJECTIVES: To determine possible variables with prognostic relevance in heart failure patients with preserved left ventricular systolic function (ejection fraction > 40%). METHODS: 157 consecutive ambulatory patients with heart failure were assessed; those patients with ejection fraction > 40% were included in the study (n = 46). All patients were evaluated by clinical interview and physical examination, ECG, echocardiogram (M-mode, 2D and pulsed Doppler of mitral flow), biochemical study and determination of type B natriuretic peptide (BNP). The patients were grouped according to the rhythm presented on ECG: Group I--patients with atrial fibrillation; Group II--patients in sinus rhythm Group II was further subdivided in two groups according to the presence or absence of restrictive left ventricular filling pattern. All patients had a clinical follow-up, with recording of events (death or hospitalization from cardiac cause). The mean follow-up time was 682.2 +/- 55 days. RESULTS: The mean age of the patients was 70.4 +/- 1.2 years; 54.3% were women; mean ejection fraction was 49.6 +/- 1%; mean BNP levels were 202.9 +/- 41.3 pg/ml. Mortality was 19.6% and the combined event death or hospitalization from cardiac cause) occurred in 26.1% of the patients. Among the clinical, demographic, biochemical, echocardiographic and neurohumoral parameters, only BNP levels had prognostic significance in the whole population. In Group II patients, BNP levels, heart rate and restrictive left ventricular filling pattern were identified as having prognostic significance. Kaplan-Meyer curve analysis showed that both BNP and restrictive left ventricular filling pattern seemed to be important prognostic markers. CONCLUSIONS: This preliminary study suggests thar neurohumoral activity (determined by plasma BNP levels) and a restrictive ventricular filling pattern may be important factors in prognostic stratification of heart failure patients with preserved left ventricular systolic function.     

Short term simvastatin use in patients with heart failure of ischemic origin. Changes of blood lipids, markers of inflammation and left ventricular function

AIM: To study changes of left ventricular function and some markers of inflammation during use of simvastatin in patients with ischemic systolic heart failure. METHODS: Statin naive patients (n=70) with coronary heart disease (CHD), NYHA class II-IV HF and LV ejection fraction (EF) 35% or less after 1 month of stabilization were randomized to simvastatin 40 mg/day (n=36) or no statin (n=34). Lipids, tumor necrosis factor alpha (TNF), and C-reactive protein (CRP) were measured and echocardiography carried out at baseline and in 4 months. In patients with sinus rhythm (n=48) left ventricular diastolic function was assessed by Doppler echo. Seven patients were not restudied and analysis included data from 32 (statin) and 31 (control) patients. RESULTS: Groups were similar except baseline CRP which was significantly higher in controls. In statin treated patients reduction of low density lipoprotein (LDL) cholesterol (CH) was 42%, triglyceride levels also significantly decreased. High density lipoprotein CH rose by 14.4 and 12.9% in statin and control groups, respectively. Despite lower initial level decrease of CRP was significant only in statin group. No significant changes of TNF occurred in either group. Left ventricular EF rose equally in statin treated (+5.7+/-4.7%) and untreated (+4.1+/-4.6%) patients (p=ns). Significant increase of peak atrial filling velocity (A) and decrease of E/A in statin group were difficult to interpret in the presence of systolic dysfunction. CONCLUSION: Short term simvastatin use in patients with systolic heart failure due to CHD caused lowering of LDLCH and CRP however this was not associated with changes of left ventricular EF different from those in control group.     

Mechanisms of improved left ventricular function following intravenous MDL 17,043 in patients with severe chronic heart failure

To evaluate the mechanisms for improved left ventricular function with MDL 17,043 in patients with severe chronic heart failure, 24 patients were evaluated by simultaneous determination of hemodynamics by right heart catheterization and ejection fraction by computerized nuclear probe before and following intravenous administration of MDL 17,043 (mean cumulative dose 3.6 mg/kg). Following MDL 17,043, there was an increase in cardiac index (+62%), stroke volume index (+42%), and stroke work index (+68%), together with a decrease in pulmonary capillary wedge pressure (-46%), indicating improved left ventricular pump function. There was a marked reduction in systemic vascular resistance (-40%) and a modest reduction in arterial pressure, indicating decreased left ventricular outflow resistance. The ratio of peak systolic blood pressure to calculated left ventricular end-systolic volume tended to increase, but the change was not statistically significant. Despite a marked increment in stroke volume index, left ventricular ejection time corrected for heart rate was shortened, suggesting enhanced contractility. In the group as a whole, the calculated left ventricular end-diastolic volume remained unchanged, but it increased in 14 patients. Since pulmonary capillary wedge pressure fell in each patient, this suggests improved overall left ventricular distensibility. Thus, decreased left ventricular outflow resistance, and possibly increased contractile function, and improved left ventricular diastolic compliance may all contribute to improved left ventricular pump function with MDL 17,043 in patients with severe heart failure.