Systolic Dysfunction in Heart Failure with a Normal Ejection Fraction: Echo-Doppler Measurements

Subclinical Left Ventricular Longitudinal Systolic Dysfunction in Hypertension With No Evidence of Heart Failure

“…15 In these patients, normal global LVEF is maintained by preservation of radial systolic function. 6,7 In the present study, peak systolic annular velocity during isovolumic contraction time could not discriminate between DHF patients and asymptomatic hypertensive patients. Long-axis shortening during isovolumic contraction period causes cavity shape to become more spherical and may affect ejection forces.…”

“…Several recent studies have demonstrated that the majority of patients with DHF have associated subclinical systolic dysfunction, which can be assessed by TDI. [5][6][7][8][9][10][11] Thus, it likely appears that isolated diastolic dysfunction is uncommon, and that the main difference between systolic and diastolic HF is the severity of LV remodeling (increase in ventricular volume and change in shape) and the degree of LV systolic dysfunction. 20 In the present study, we sought to determine the prevalence of subclinical systolic dysfunction in hypertensive patients with normal LVEF and no history of HF using mitral annular velocity recordings from 4 sites in the apical 4-and 2-chamber views.…”

Heart Failure With Preserved Ejection Fraction: Is it Due to Contractile Dysfunction?

“…In clinical observational studies there is a 26-40% increase in left ventricular mass, but with a relatively normal end-diastolic volume compared with controls. [2][3][4] Furthermore, it has been demonstrated repeatedly that there are significant systolic function abnormalities of strain, strain rate and tissue Doppler 5 and that these correlate (r=0.81) with the severity of the diastolic dysfunction in both HFPEF and in heart failure with a reduced EF. 6 Further, sarcomeric hypertrophic cardiomyopathies are disorders of the contractile proteins and display myocardial disarray; both these abnormalities would be expected to cause contractile dysfunction and yet the EF is usually normal or increased.…”

Reply to Letter Regarding Article, "Subclinical Left Ventricular Longitudinal Systolic Dysfunction in Hypertension With No Evidence of Heart Failure"

“…3 Because longitudinally directed myocardial fibers are mainly located in the subendocardium, long-axis function therefore largely reflects subendocardial function, which is a sensitive marker of myocardial ischemia. 4,5 It also provides the opportunity for detecting subclinical systolic dysfunction in asymptomatic patients with diabetes and hypertension. 1,6 Early echocardiographic studies of mitral annular movement have been performed using M-mode echocardiography, or tedious frame-byframe analysis for 2-dimensional (D) images.…”

“…In addition to widespread routine use because of its simplicity, good inter-and intraobserver variabilities for tissue Doppler velocity measurements at the mitral annulus are another merit for the application of tissue Doppler imaging for LV longitudinal function. 1,5 Although Dr Tsilakis claims that tissue Doppler imaging cannot discriminate between active contraction and passive drawing motion and rotation of the whole heart, or contraction of adjacent segments, exactly the same problems occur when using M-mode echocardiography for the assessment of LV longitudinal function. Application of strain and strain rate imaging can overcome these problems.…”