Left ventricular systolic function is abnormal in diastolic heart failure: re-assessment of systolic function using cardiac time interval analysis.

OBJECTIVES

The purpose of this study was to re-assess the left ventricular (LV) systolic function in diastolic heart failure (DHF) using Doppler echocardiography.

BACKGROUND

Systolic function in DHF is defined as the preserved LV ejection fraction (EF). EF may not fully reflect the systolic function in DHF, especially in the presence of abnormalities during the isovolumetric contraction time (ICT).

METHODS

We examined LV systolic and diastolic function in 80 consecutive patients with DHF, 30 patients with asymptomatic diastolic dysfunction (ADD), and 30 normal subjects (Control). The LV and left atrial volumes, LV EF, LV ICT, and isovolumetric relaxation time (IRT), early diastolic mitral flow velocity, systolic mitral annular velocity (S'), and early diastolic mitral annular velocity were obtained.

RESULTS

LV ICT in DHF (69+/-30 ms) was significantly increased compared to those with ADD (37+/-23 ms) and Control (35+/-26 ms) (P<0.0001). ICT in ADD was equal to that in Control. The LV end-diastolic volume index in DHF (49+/-14 ml/m(2)) was significantly increased compared to those with ADD (42+/-12 ml/m(2)) and Control (43+/-8 ml/m(2)) (P<0.05). S' in DHF (5.9+/-1.4 cm/s) and ADD (6.7+/-1.1 cm/s) was significantly decreased compared to that in Control (8.7+/-2.5 cm/s).

CONCLUSIONS

Our results revealed that the major differences between ADD and DHF were global and longitudinal LV systolic dysfunction and LV enlargement. This study suggests that LV systolic dysfunction plays an important role in the development of DHF.