Diastolic heart failure (DHF) is usually defined as symptoms and signs of HF with normal ejection fraction(EF) and diastolic dysfunction (DD). It has been reported that 20 to 40% of patients with CHF and normal EF have a reduction of LV “contractility”. To address this controversial issue four speakers made excellent presentations.
Dr. D. Burkhoff showed experimental and clinical data of increased plasma volume in hypertensive patients with HF and normal EF, and increased LVEDV, even in patients without HF.
Dr.J.E. Sanderson presented echocardiographic data demonstrating decreased peak systolic velocity in tissue Doppler imaging in patients with DHF and more so in those with SHF, early diastolic velocities being similar.
Long axis function may be low in patients with DHF. EF may persist as normal due to radial function keeping normal. He suggested that we should talk of HF without mention of EF. A mixture of abnormal systolic and DD would be present and no separate diseases would exist.
Dr. B.M. Pieske presented data suggesting that DHF and SHF are the mere extremes of a continuous spectrum of phenotypes of the same disease. They would not be a single disease and there are ultrastructural differences between the two, as well as different remodeling of the LV (concentric vs. eccentric remodeling) to support this idea.
Dr. V.Melenovsky showed interesting data on the extraventricular aspects in DHF, namely increased arterial stiffness, increased left atrial (LA) volume and decreased LA contractile reserve, as well as decreased augmentation of CO due to blunted HR response because of autonomic dysfunction, and inadequate vasodilatation.