Subtle Systolic Dysfunction May Be Associated with the Tendency to Develop Diastolic Heart Failure in Patients with Preserved Left Ventricular Ejection Fraction

Background: We looked for an answer to the question of whether diastolic heart failure (DHF) is a reality or all heart failures are systolic. Method: 300 cases (hypertensive, aged, obese, etc.), not being diagnosed DHF, with preserved left ventricular (LV) ejection fraction (EF) but having the tendency to develop DHF in future were examined. One hundred and eighty cases without exclusion criteria were selected. Cases were assigned to three groups according to noninvasively obtained pulmonary capillary wedge pressure (PCWP). Results: In cases with higher PCWP (> 10 mmHg), transmitral A velocity was increased (P < 0.001) and among the pulsed wave tissue Doppler imaging (pw-TDI) parameters Ea velocity was decreased (P < 0.001) and Ea-dt was prolonged (P < 0.005). In cases with lower PCWP (< 8 mmHg), transmitral E velocity was higher (P < 0.001). Furthermore, a more meaningful relationship was found between PCWP and systolic pw-TDI parameters. In all the groups, it was observed that Sa velocity was progressively decreased and Q-Sa interval was progressively prolonged as PCWP increased (for all the groups P < 0.046). Conclusion: The question whether DHF is a reality or all heart failures are systolic may be answered as follows. Subtle systolic dysfunction may be associated with the tendency to develop DHF in patients with preserved LV ejection fraction. As in systolic heart failure (EF < 45%), in patients with preserved systolic function (EF >= 45%), systolic and diastolic functions may impair together. The pw-TDI method may be more sensitive than standard echocardiography parameters in detection of systolic dysfunction in cases with preserved EF. (ECHOCARDIOGRAPHY, Volume 26, April 2009).