Background Patients with signs and symptoms of heart failureand a normal left ventricular ejection fraction are said tohave diastolic heart failure. It has traditionally been thoughtthat the pathophysiological cause of heart failure in thesepatients is an abnormality in the diastolic properties of theleft ventricle; however, this hypothesis remains largely unproven.
Methods We prospectively identified 47 patients who met thediagnostic criteria for definite diastolic heart failure; allthe patients had signs and symptoms of heart failure, a normalejection fraction, and an increased left ventricular end-diastolicpressure. Ten patients who had no evidence of cardiovasculardisease served as controls. Left ventricular diastolic functionwas assessed by means of cardiac catheterization and echocardiography.
ResultsThe patients with diastolic heart failure had abnormalleft ventricular relaxation and increased left ventricular chamberstiffness. The mean (±SD) time constant for the isovolumic-pressuredecline () was longer in the group with diastolic heart failurethan in the control group (59±14 msec vs. 35±10msec, P=0.01). The diastolic pressure–volume relationwas shifted up and to the left in the patients with diastolicheart failure as compared with the controls. The corrected leftventricular passive-stiffness constant was significantly higherin the group with diastolic heart failure than in the controlgroup (0.03±0.01 vs. 0.01±0.01, P<0.001).
Conclusions Patients with heart failure and a normal ejectionfraction have significant abnormalities in active relaxationand passive stiffness. In these patients, the pathophysiologicalcause of elevated diastolic pressures and heart failure is abnormaldiastolic function.
Source Information
From the Cardiology Division, Department of Medicine, Gazes Cardiac Research Institute, Medical University of South Carolina; and the Ralph H. Johnson Department of Veterans Affairs Medical Center — both in Charleston, S.C. (M.R.Z., C.F.B.); the Department of Cardiovascular Medicine, Lahey Clinic, Burlington, Mass. (W.H.G.); and the Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Mass. (W.H.G.).
Address reprint requests to Dr. Zile at Cardiology/Medicine, Medical University of South Carolina, 135 Rutledge Ave., Suite 1201, P.O. Box 250592, Charleston, SC 29425, or at zilem{at}musc.edu.
Diastolic Heart Failure
Maurer M. S., Packer M., Burkhoff D., King D. L., Grieff M., Zile M. R., Baicu C. F., Gaasch W. H., Redfield M. M.
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N Engl J Med 2004;
351:1143-1145, Sep 9, 2004.
Correspondence
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) was longer in the group with diastolic heart failure than in the control group (59±14 msec vs. 35±10 msec, P=0.01). The diastolic pressure–volume relation was shifted up and to the left in the patients with diastolic heart failure as compared with the controls. The corrected left ventricular passive-stiffness constant was significantly higher in the group with diastolic heart failure than in the control group (0.03±0.01 vs. 0.01±0.01, P<0.001). 
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