Diastolic dysfunction: pathophysiology, clinical features, and assessment with radionuclide methods

Basic to our understanding of heart failure is the distinction between systolic and diastolic ventricular dysfunction. Diastolic dysfunction implies that the ventricle cannot accept blood at normally low pressures. The ventricular filling pattern and the relation between ventricular diastolic pressure and volume reflect a dynamic interaction between time course of relaxation, conversion of elastic forces into elastic recoil, and the passive properties of the ventricle. In the early part of diastolic filling, the pressure-volume relationship is influenced primarily by relaxation; in the latter part of diastole, passive filling properties are important. Mitral inflow patterns reflect these time-varying filling dynamics and are commonly assessed with echocardiography. Disorders of diastolic filling are observed in patients with heart failure with normal ejection fraction, myocardial ischemia, and even dilated cardiomyopathy. Patients with concentric ventricular hypertrophy, normal ejection fraction, and heart failure are the prototype of patients with diastolic dysfunction. In this article we review the physiology and pathophysiology of diastole and the main clinical disorders associated with diastolic dysfunction, and we outline in brief the application of radionuclide techniques in the assessment of diastolic dysfunction.