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Combined systolic and diastolic dysfunction in the presence of preserved left ventricular ejection fraction

Ian P Clements1

  • 1Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States. lovejoy.margery@mayo.edu

European Journal of Heart Failure
|June 1, 2005
PubMed

Insights

Preserved left ventricular ejection fraction (LVEF) in heart failure patients often indicates both systolic and diastolic dysfunction. This study found reduced LV end-systolic volume and increased peak ejection rate with higher LVEF.

Area of Science:

  • Cardiology
  • Cardiovascular Physiology
  • Echocardiography

Background:

  • Heart failure with preserved left ventricular ejection fraction (LVEF) is typically associated with isolated diastolic dysfunction.
  • This study investigates the presence of both systolic and diastolic dysfunction in patients with preserved LVEF.

Purpose of the Study:

  • To determine if systolic and diastolic dysfunction coexist in patients with preserved LVEF.
  • To analyze the relationship between LVEF ranges and indicators of cardiac dysfunction.

Main Methods:

  • Utilized equilibrium resting radionuclide ventriculograms from 439 patients with LVEF >/=0.50.
  • Measured LV peak filling rate (PFR) and peak ejection rate (PER).
  • Compared patients across low-normal (0.50-0.58), intermediate-normal (0.59-0.64), and high-normal (0.65-0.94) LVEF groups.

Main Results:

  • LV end-systolic volume decreased significantly with increasing LVEF (P<0.0001).
  • Both PFR and PER increased significantly with higher LVEF (P<0.0001).
  • The prevalence of abnormal PFR and PER decreased as LVEF increased.

Conclusions:

  • Preserved LVEF in heart failure is frequently linked to underlying LV systolic dysfunction, evidenced by enlarged LV end-systolic volume and low PER.
  • Diastolic dysfunction, indicated by decreased PFR, is also commonly observed.
  • These findings challenge the notion of isolated diastolic dysfunction in all preserved LVEF heart failure cases.
Abstract

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