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(Circulation. 2005;112:2888-2890.)
© 2005 American Heart Association, Inc.

Editorial

Diastolic Dysfunction Beyond Distensibility

Adverse Effects of Ventricular Dilatation

William C. Little, MD

From the Section of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC.

Correspondence to William C. Little, MD, Cardiology Section, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157-1045. E-mail wlittle@wfubmc.edu

Key Words: Editorials • diastole • heart failure • echocardiography

An extract of the first 250 words of the full text is provided, because this article has no abstract.

In order for the left ventricle (LV) to function as an effective pump, it must not only be able to empty but also to fill without requiring an elevated left atrial pressure. Furthermore, the stroke volume must be able to increase in response to stress, such as exercise, without much increase in left atrial pressure. Thus, LV diastolic function is an important determinant of cardiac performance.

Article p 2921

Diastolic function has conventionally been assessed on the basis of the LV end-diastolic pressure-volume relation (Figure 1). A shift of this curve upward and to the left (curve A, Figure 1) has been considered to be the hallmark of diastolic dysfunction. In this situation, each LV end-diastolic volume is associated with a higher end-diastolic pressure, and therefore, the ventricle is less distensible.

View larger version (11K): [in this window] [in a new window]   Figure 1. LV end-diastolic pressure-volume relations. Stiffnesses at typical operating points are shown as the change in pressure (P) divided by the change in volume (V). See text for discussion.

In contrast, in dilated cardiomyopathy, the LV end-diastolic pressure-volume relation is shifted substantially to the right (curve B, Figure 1). In this situation, each volume is associated with a lower pressure; thus, the ventricle is more distensible. This has been interpreted as indicating there is enhanced diastolic function. However, patients with dilated cardiomyopathy have abnormal LV filling dynamics, elevated left atrial pressure, and an inability to increase stroke volume without further elevation of left atrial pressure. The severity of heart failure and prognosis . . . [Full Text of this Article]

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