Left ventricular long axis function in diastolic heart failure is reduced in both diastole and systole: time for a redefinition?

• Published in: Heart (British Cardiac Society) Vol. 87; no. 2; pp. 121 - 125
• Main Authors: Yip, G, Wang, M, Zhang, Y, Fung, J W H, Ho, P Y, Sanderson, J E
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Cardiovascular Society 01-02-2002; BMJ; BMJ Publishing Group Ltd; BMJ Publishing Group LTD; Copyright 2002 by Heart
• Subjects: Adult; Age; Aged; Aged, 80 and over; ALAX; AMV; Biological and medical sciences; Blood Flow Velocity - physiology; Cardiac Output, Low - diagnosis; Cardiac Output, Low - physiopathology; Cardiovascular disease; Cardiovascular Medicine; Cardiovascular system; Case-Control Studies; Contraction; deceleration time in early filling phase; deceleration time of early mitral annular diastolic excursion; deceleration time of the peak early Doppler mitral filling velocity; diastole; Diastole (Cardiac cycle); Diastole - physiology; DTLAX; DTMV; E/AMV; early diastolic myocardial velocity by colour Doppler myocardial imaging; early mitral diastolic excursion by long axis M mode echocardiography; early transmitral flow velocity; Echocardiography, Doppler - methods; ELAX; EMV; fractional shortening; Heart; Heart attacks; Heart failure; Heart rate; Heart ventricle, Left; Humans; Hypertension; Investigative techniques, diagnostic techniques (general aspects); isovolumic myocardial relaxation time by colour Doppler myocardial imaging; isovolumic relaxation time from the Doppler mitral and aortic flow pattern; IVRTm; IVRTMV; late diastolic annular motion by long axis M mode echocardiography; late diastolic myocardial velocity by colour Doppler myocardial imaging; late transmitral flow velocity; left ventricular ejection fraction; left ventricular ejection fraction from atrioventricular plane method; left ventricular end diastolic dimension; left ventricular end diastolic internal dimension index; left ventricular end diastolic volume index; long axis; LVEDD; LVEDIDI; LVEDVI; LVEF; LVEFAVPD; Measurement; Medical sciences; Middle Aged; mitral annular excursion in systole by long axis M mode echocardiography; mitral annular velocities by colour Doppler myocardial imaging; Mitral Valve - physiology; Myocardial Contraction - physiology; Physiological aspects; ratio of early to late Doppler mitral inflow velocities; SLAX; systole; Systole - physiology; Ultrasonic investigative techniques; Variance analysis; Velocity; Ventricular Dysfunction, Left - diagnosis; Ventricular Dysfunction, Left - physiopathology; Sonography; Doppler ultrasound study; Human; Heart failure; Echocardiography; Diastole; Pathophysiology; Cardiovascular disease; Exploration; Systole; Heart disease; Technique; Left ventricle performance; Ejection fraction
• ISSN: 1355-6037; 1468-201X
• DOI: 10.1136/heart.87.2.121

Objective: To test the hypothesis that, when measured in the long axis, left ventricular systolic function is abnormal in patients with diastolic heart failure. Design: A case–control study. Setting: University teaching hospital (tertiary referral centre). Patients: 68 patients with heart failure, 29 with a left ventricular ejection fraction (LVEF) of > 0.45 and diastolic dysfunction (diastolic heart failure), 39 with an LVEF of ≤ 0.45 (systolic heart failure), and 105 normal subjects, including 33 age matched controls. Methods: LVEF was measured by cross sectional Simpson's method, and mitral annular amplitudes and velocities by M mode and tissue Doppler echocardiography, respectively, along with mitral Doppler inflow velocities. Results were compared between the three groups. Main outcome measures: Peak systolic mitral annular velocity and amplitude between the different groups. Results: The mitral annular peak mean velocity and amplitude in systole were lower in the patients with diastolic heart failure (mean (SEM), 4.8 (0.2) cm/s) than in the age matched normal controls (6.1 (0.14) cm/s), but higher than those with systolic heart failure (2.8 (0.13) cm/s) (all p < 0.001). Similar changes were seen the mitral annular amplitude during systole. Peak early diastolic velocity and amplitude were also significantly reduced in the group with diastolic heart failure. Left ventricular hypertrophy was evident in over 95% patients in both diastolic and systolic heart failure groups, with a comparable left ventricular mass index. Conclusions: In patients with diastolic heart failure and evidence of left ventricular hypertrophy, there is systolic left ventricular impairment as measured by myocardial Doppler imaging of the longitudinal axis. Thus subtle abnormalities of systolic function are present in patients with heart failure and a normal left ventricular ejection fraction, and there appears to be a continuum of systolic function between those with truly normal, mildly impaired (labelled diastolic heart failure), and obviously abnormal left ventricular systolic function. Isolated diastolic dysfunction is uncommon.