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Left ventricular long axis function in diastolic heart failure is reduced in both diastole and systole: time for a redefinition?
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  1. G Yip,
  2. M Wang,
  3. Y Zhang,
  4. J W H Fung,
  5. P Y Ho,
  6. J E Sanderson
  1. Division of Cardiology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
  1. Correspondence to:
    Professor J E Sanderson, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, 9th Floor, Clinical Science Building, Prince of Wales Hospital, Hong Kong, SAR, China;
    jesanderson{at}cuhk.edu.hk

Abstract

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.

  • diastole
  • systole
  • heart failure
  • long axis
  • ALAX, late diastolic annular motion by long axis M mode echocardiography
  • Am, late diastolic myocardial velocity by colour Doppler myocardial imaging
  • AMV, late transmitral flow velocity
  • DT, deceleration time in early filling phase
  • DTLAX, deceleration time of early mitral annular diastolic excursion
  • DTMV, deceleration time of the peak early Doppler mitral filling velocity
  • E/AMV, ratio of early to late Doppler mitral inflow velocities
  • ELAX, early mitral diastolic excursion by long axis M mode echocardiography
  • Em, early diastolic myocardial velocity by colour Doppler myocardial imaging
  • EMV, early transmitral flow velocity
  • FS, fractional shortening
  • IVRTm, isovolumic myocardial relaxation time by colour Doppler myocardial imaging
  • IVRTMV, isovolumic relaxation time from the Doppler mitral and aortic flow pattern
  • LVEFAVPD, left ventricular ejection fraction from atrioventricular plane method
  • LVEDD, left ventricular end diastolic dimension
  • LVEDVI, left ventricular end diastolic volume index
  • LVEF, left ventricular ejection fraction
  • LVEDIDI, left ventricular end diastolic internal dimension index
  • SLAX, mitral annular excursion in systole by long axis M mode echocardiography
  • Sm, mitral annular velocities by colour Doppler myocardial imaging
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