Published online before print April 25, 2005, doi: 10.1161/01.CIR.0000164273.57823.26
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(Circulation. 2005;111:2306-2312.)
© 2005 American Heart Association, Inc.
Heart Failure |
Left Ventricular Systolic Performance, Function, and Contractility in Patients With Diastolic Heart Failure
From the Division of Cardiology, Department of Medicine, Medical University of South Carolina and RHJ Department of Veterans Affairs Medical Center (C.F.B., M.R.Z.), Charleston, SC; Division of Cardiology, Department of Medicine, University of Massachusetts Medical School (G.P.A.), Worcester, Mass; and the Department of Cardiovascular Medicine, Lahey Clinic (W.H.G.), Burlington, Mass.
Reprint requests to Michael R. Zile, MD, Division of Cardiology, Department of Medicine, Medical University of South Carolina, 135 Rutledge Ave, Suite 1201, PO Box 250592, Charleston, SC 29425. E-mail zilem{at}musc.edu
Received November 2, 2004; revision received January 12, 2005; accepted January 21, 2005.
Background— Patients with diastolic heart failure (DHF) have significant abnormalities in left ventricular (LV) diastolic function, including slow and delayed relaxation and increased chamber stiffness. Whether and to what extent these abnormalities in diastolic function occur in association with abnormalities in LV systolic performance, function, and contractility has not been investigated thoroughly.
Methods and Results— The systolic properties of the LV were examined in 75 patients with heart failure and a normal ejection fraction (ie, DHF) and 75 normal control subjects with no evidence of cardiovascular disease. LV systolic properties were assessed with echocardiographic and cardiac catheterization data. Stroke work (an index of LV systolic performance), preload recruitable stroke work and ejection fraction (indices of LV systolic function), systolic stress-shortening relationship, end-systolic pressure-volume relationship, and peak (+)dP/dt (indices of LV contractility) were examined. The systolic properties of the LV were normal in patients with DHF. Stroke work was 8.4±2.3 in DHF versus 8.8±2.5 kg · cm in controls (P=0.26). Preload recruitable stroke work was 99±22 in DHF versus 109±18 g/cm2 in controls (P=0.13). The relationship between stroke work and end-diastolic volume was similar in DHF and controls. Peak (+) dP/dt was 1596±362 in DHF versus 1664±305 mm Hg/s in controls (P=0.54). The end-systolic pressure-volume relationship was increased in DHF. The systolic stress versus endocardial fractional shortening relationship was similar in DHF and controls.
Conclusions— Patients with DHF had normal LV systolic performance, function, and contractility. The pathophysiology of DHF does not appear to be related to significant abnormalities in these systolic properties of the LV.
Key Words: heart failure • systole • diastole • contractility
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