Progression of systolic abnormalities in patients with "isolated" diastolic heart failure and diastolic dysfunction
Cheuk-Man Yu1, Hong Lin, Hua Yang
1Division of Cardiology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong. cmyua@hkucc.hku.hk
Insights
Diastolic heart failure (DHF) often coexists with systolic dysfunction, challenging traditional diagnostic criteria. Tissue Doppler imaging reveals subtle systolic abnormalities in DHF patients, suggesting a spectrum of heart failure.
Area of Science:
- Cardiology
- Echocardiography
- Heart Failure Pathophysiology
Background:
- Diastolic heart failure (DHF) diagnosis relies on excluding systolic dysfunction.
- The ejection fraction (EF) cutoff of 50% may be insufficient for accurate DHF diagnosis.
- Systolic dysfunction is suspected to be prevalent in DHF patients.
Purpose of the Study:
- To investigate the presence and extent of systolic abnormalities in patients diagnosed with DHF using tissue Doppler imaging.
- To evaluate the diagnostic utility of myocardial velocities in differentiating heart failure subtypes.
Main Methods:
- Echocardiography with tissue Doppler imaging was performed on 339 subjects, including patients with systolic heart failure (SHF), DHF, isolated diastolic dysfunction (DD), and normal controls.
- Regional myocardial velocity curves (S(M) and E(M)) were analyzed using a standardized segmental model.
- A threshold for mean S(M) was established to predict systolic dysfunction.
Main Results:
- Patients with SHF, DHF, and DD exhibited significantly lower peak regional systolic (S(M)) and early diastolic (E(M)) myocardial velocities compared to controls.
- Mean S(M) and E(M) values were significantly reduced across all disease groups, with SHF < DHF < DD < controls for S(M), and SHF = DHF < DD < controls for E(M).
- A mean S(M) of 4.4 cm/s predicted systolic dysfunction in 92% of SHF, 52% of DHF, and 14% of DD patients.
Conclusions:
- Tissue Doppler imaging identified systolic abnormalities in patients previously diagnosed with DHF and isolated DD.
- These findings suggest a common coexistence of systolic and diastolic dysfunction in heart failure.
- Heart failure may represent a spectrum of severity involving both systolic and diastolic dysfunction.
Background:
The definition of diastolic heart failure (DHF) relies on the use of sensitive tools to exclude the presence of systolic dysfunction. The use of ejection fraction (EF) of 50% as the cutoff point may not be adequate to address such a task. We believe that systolic dysfunction is common in DHF.
Methods And Results:
Echocardiography with tissue Doppler imaging was performed in 339 subjects, of whom 92 had systolic heart failure (SHF) (EF<50%), 73 had DHF (EF > or = 50% with diastolic abnormalities on Doppler echocardiography), and 68 had isolated diastolic dysfunction (DD); 106 were normal control subjects. Regional myocardial velocity curves were constructed off-line with the use of a 6-basal, 6-midsegmental model. The peak regional myocardial sustained systolic (S(M)) and early diastolic (E(M)) velocities were significantly lower in patients with SHF, DHF, and DD than in control subjects in almost all the myocardial segments. Likewise, the mean S(M) (SHF
Conclusions:
Through the use of tissue Doppler imaging, systolic abnormalities were evident in patients previously labeled as DHF and to a much lesser extent, isolated DD. This indicates the common coexistence of systolic and diastolic dysfunction in a spectrum of different severity in the pathophysiological process of heart failure.
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