Letter by Razzolini and Tarantini Regarding Article, “Restrictive Left Ventricular Filling Pattern Does Not Result From Increased Left Atrial Pressure Alone”
To the Editor:
We congratulate Masutani and colleagues1 on their insightful article distinguishing a restrictive filling pattern due to an overfilled normal left ventricle from one due to a failing enlarged left ventricle. We do not think, however, that the differences they found in diastolic parameters are due to primary diastolic dysfunction, as they claim. In fact, they compared 3 groups of dogs: a control group (C), a volume overloaded group (VOL), and a group with systolic heart failure induced by rapid ventricular pacing (HF). Therefore, the differences in diastolic parameters between VOL and HF groups are obviously due primarily to a systolic, not diastolic, dysfunction. Moreover, the difference in average operative compliance (KLV) does not mean that the 3 groups belong to 3 different passive pressure-volume curves: the average KLV in group C could well be the average of the flat portion, whereas KLV in group HF could be the average of the steep portion and KLV in group VOL could be the average of both portions of the same pressure-volume curve.
We think that the article is an elegant proof that heart failure with systolic dysfunction can induce a secondary alteration in diastolic parameters but is not proof of a primary diastolic dysfunction.