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(Circulation. 2006;113:296-304.)
© 2006 American Heart Association, Inc.

Contemporary Reviews in Cardiovascular Medicine

Contractile Behavior of the Left Ventricle in Diastolic Heart Failure

With Emphasis on Regional Systolic Function

Gerard P. Aurigemma, MD; Michael R. Zile, MD; William H. Gaasch, MD

From the Division of Cardiology, Department of Medicine, University of Massachusetts Medical School, Worcester (G.P.A.); Division of Cardiology, Department of Medicine, Medical University of South Carolina and RHJ Department of Veterans Affairs Medical Center, Charleston, SC (M.R.Z.); and Department of Cardiovascular Medicine, Lahey Clinic, Burlington, Mass (W.H.G.).

Correspondence to Gerard P. Aurigemma, MD, Division of Cardiology, Department of Medicine, University of Massachusetts Medical School, Room S3-860, 55 Lake Ave N, Worcester, MA 01655. E-mail aurigemg@ummhc.org

Received March 31, 2005; revision received July 15, 2005; accepted July 21, 2005.

Key Words: diastole • echocardiography • ventricles

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

	Introduction

 
In diastolic heart failure, the left ventricular (LV) ejection fraction (EF) is normal and there is increased passive stiffness with impaired relaxation of the ventricle, resulting in disturbances in the pattern of filling and elevated diastolic pressure.^1–3 The mechanism underlying such failure has been thought to be principally diastolic because LV diastolic function is universally abnormal and systolic performance, function, and contractility are normal.⁴ However, several reports suggest that abnormalities in regional shortening are present in diastolic heart failure.^5–9 The significance of these findings, especially their relation to the syndrome of heart failure, remains uncertain. Accordingly, we will review some of the structural and functional differences between systolic and diastolic heart failure, and, emphasizing the systolic or contractile behavior of the left ventricle, we will attempt to reconcile what appear to be disparate conclusions about LV systolic function in patients with diastolic heart failure.

	Structural Remodeling

 
The hearts of patients with systolic heart failure differ dramatically from those of patients with diastolic heart failure in regard to both gross and microscopic anatomic features. As will be seen, these anatomic differences tend to parallel physiological and functional differences in systolic and diastolic heart failure^10,11 (Table 1).

View this table: [in this window] [in a new window]   TABLE 1. LV Structure and Function in Chronic Heart Failure

LV Chamber Remodeling
Patients with diastolic heart failure generally exhibit a concentric pattern of LV remodeling and a hypertrophic process that is characterized by a normal or near-normal end-diastolic volume, increased wall thickness, and a high ratio of mass to volume with a high ratio of wall thickness . . . [Full Text of this Article]

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