Contractile Behavior of the Left Ventricle in Diastolic Heart Failure

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Abstract
Received March 31, 2005; revision received July 15, 2005; accepted July 21, 2005. In diastolic heart failure, the left ventricular (LV) ejection fraction (EF) is normal and there is increased passive stiffness with impaired relaxation of the ventricle, resulting in disturbances in the pattern of filling and elevated diastolic pressure.1–3 The mechanism underlying such failure has been thought to be principally diastolic because LV diastolic function is universally abnormal and systolic performance, function, and contractility are normal.4 However, several reports suggest that abnormalities in regional shortening are present in diastolic heart failure.5–9 The significance of these findings, especially their relation to the syndrome of heart failure, remains uncertain. Accordingly, we will review some of the structural and functional differences between systolic and diastolic heart failure, and, emphasizing the systolic or contractile behavior of the left ventricle, we will attempt to reconcile what appear to be disparate conclusions about LV systolic function in patients with diastolic heart failure. The hearts of patients with systolic heart failure differ dramatically from those of patients with diastolic heart failure in regard to both gross and microscopic anatomic features. As will be seen, these anatomic differences tend to parallel physiological and functional differences in systolic and diastolic heart failure10,11 (Table 1). View this table: TABLE 1. LV Structure and Function in Chronic Heart Failure ### LV Chamber Remodeling Patients with diastolic heart failure generally exhibit a concentric pattern of LV remodeling and a hypertrophic process that is characterized by a normal or near-normal end-diastolic volume, increased wall thickness, and a high ratio of mass to volume with a high ratio of wall thickness to chamber radius.12 By contrast, patients with systolic heart failure exhibit a pattern of eccentric remodeling with an increase in end-diastolic volume, little increase in wall thickness, and a substantial decrease in the ratio …