IntroductionWith respect to the recent clinical issue of isolated left ventricular (LV) diastolic dysfunction, many studies have reported that 30% to 40% of patients with congestive heart failure (CHF) have preserved LV systolic function [1][2][3]. When pulmonary congestion, that is, an increase in left atrial pressure, is observed in such patients, the transmitral flow (TMF) velocity shows a pseudonormalized or restrictive pattern in many of the patients [4,5]. However, in clinical practice, the peak early diastolic TMF velocity (E) is lower than the peak atrial systolic TMF velocity (A) (E/A<1) in most patients with LV diastolic dysfunction, suggesting relaxation abnormalities. Therefore, it is difficult to predict whether isolated diastolic dysfunction will cause CHF in the future in individual patients with E/A<1. Douglas [6] indicated that the left atrial size reflects the history of LV diastolic dysfunction, and that the level of left atrial enlargement is associated with the serum HbA1c concentration in patients with diabetes. The development of ultrasonic strain imaging has facilitated the evaluation of regional myocardial systolic and diastolic function and is not influenced by whole heart motion or tethering [7]. In the present study, we divided patients, in whom LV pump function was maintained with TMF showing a relaxation abnor-
AbstractBackground. Little is known of the pathophysiologic characteristics of a common disease cohort with congestive heart