Abstract 3816: Does Diastolic Heart Failure Evolve to Systolic Heart Failure?
Diastolic heart failure (DHF) is frequently presumed to evolve over time to systolic heart failure (SHF). To verify this evolution, 10 patients with DHF (age: 69±4 years; male/female: 6/4) were followed for 64±9 months after an initial hospital admission for worsening heart failure. All patients were free of significant coronary artery disease at the initial hospitalization. Arterial hypertension, diabetes mellitus type 2 and obesity was present in respectively 70, 60 and 50% of patients. Angiotensin converting enzyme inhibitors, betablockers and calcium channel blockers were used respectively by 90, 20 and 50% of patients. Contrast left ventricular (LV) angiograms with high fidelity LV pressure recordings (n=7) and Dopplerechocardiograms (n=10) had been obtained at the initial hospitalization (INIT) and were again obtained at the end of the observation period (END). At the end of the observation period, a coronary angiogram confirmed persistent absence of significant coronary artery disease in all patients. At the end of the observation period, LV end-diastolic volume index (LVEDVI) and LV ejection fraction (LVEF) were comparable to the initial hospitalization (Table⇓). In contrast, LV end-diastolic pressure (LVEDP) and a radial LV stiffness modulus (Stiff-Mod) had risen significantly at the end of the observation period (Table⇓). Both the higher LVEDP at comparable LVEDVI and the higher Stiff-Mod were consistent with further reduction of LV diastolic distensibility over the 64±9 months observation period.
Conclusion: When development of significant coronary artery disease is excluded with sequential coronary angiograms, progression of LV dysfunction in DHF is characterized more by progressive diastolic LV stiffening than by LV dilatation or lowering of LVEF. DHF is therefore not a precursor stage of SHF.