Left atrial role in left ventricular filling at rest during exercise and during the development of heart failure

The left ventricle fills early in diastole when left ventricular pressure falls below left atrial pressure and late in diastole when atrial contraction raises left atrial pressure above left ventricular pressure. Early filling deceleration time is determined by the left ventricular early diastolic stiffness. Rapid, early tilling deceleration indicates a stiff left ventricle. During exercise, left ventricular filling rate is enhanced by more rapid left ventricular relaxation and lower early diastolic left ventricular pressures. This effect is lost after the development of heart failure. In heart failure, exercise increases left ventricular early diastolic pressure. Thus, left ventricular filling depends on an abnormal increase in left atrial pressure.