Progression of systolic abnormalities in patients with "isolated" diastolic heart failure 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 greater than or equal to 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<DHF < DD <control subjects; 3.3+/-1.0<4.6+/-1.3<5.4+/-1.0<6.3+/-1.0 cm/s; all P less than or equal to 0.001) and mean E-M (SHF=DHF<DD<control subjects: 3.6+/-1.2 =3.9+/-1.3<5.3+/-1.6<7.2+/-1.7 cm/s; all P<0.001) from the six basal segments were decreased in all the disease groups. A mean S-M of 4.4cm/s (-2 SD of control subjects) predicted the presence of systolic dysfunction in 92% of patients with SHF, 52% with DHF, and 14% with DD. 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.