Combined systolic and diastolic dysfunction in the presence of preserved left ventricular ejection fraction

Background: Heart failure with preserved left ventricular ejection fraction (LVEF) suggests isolated diastolic dysfunction. Aim: The purpose of this study was to determine if systolic and diastolic dysfunction occurred with preserved LVEF. Methods: Equilibrium resting radionuclide ventriculograms from 439 patients with an LVEF >= 0.50 were used to determine LV peak filling rate (PFR) and peak ejection rate (PER) in end-diastolic volumes per second and LV end-systolic volume (ml). Patients with low-normal (n=147; range, 0.50-0.58; mean +/- S.D., 0.53 +/- 0.02), intermediate-normal (161, 0.594-64, 0.61 +/- 0.02), and high-normal (131, 0.65-0.94, 0.72 +/- 0.06) LVEF were compared. Results: From low-normal to intennediate-normal to high-normal LVEF, LV end-systolic volume decreased (93 36, 71 33, 43 26, respectively, P < 0.0001), PFR increased (2.31 +/- 0.74, 2.58 +/- 0.74, 3.15 +/- 0.94, P < 0.0001), PER increased (-2.78 +/- 0.50, -3.13 +/- 0.47, -3.83 +/- 0.84, P < 0.0001), the percentages of patients with abnormal PFR decreased (66, 56, 40, P < 0001), and the percentage with abnormal PER decreased (47, 14, 5, P < 0.0001). Of 193 patients with preserved LVEF and abnormally low PFR, 65 (34%) had abnormally low PER. Conclusions: The results indicate that a preserved LVEF was often associated with LV systolic dysfunction (enlarged LV end-systolic volume and low PER) and LV diastolic dysfunction (decreased PFR). (c) 2004 European Society of Cardiology. Published by Elsevier B.V All rights reserved.