Left Ventricular End-Diastolic Volume Is Normal in Patients With Heart Failure and a Normal Ejection FractionA Renewed Consensus in Diastolic Heart Failure*
Michael R. Zile, MD, FACC ,* and
Martin M. LeWinter, MD, FACC
Charles Ezra Daniel Professor of Medicine, Division of Cardiology and the Gazes Cardiac Research Institute, Department of Medicine, Medical University of South Carolina and RHJ Department of Veterans Affairs Medical Center, Charleston, South Carolina
Professor of Medicine and Molecular Physiology and Biophysics, Cardiology Unit, Department of Medicine, University of Vermont, Burlington, Vermont.
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Figure 1 Histogram of Distribution of LVIDd
Normal control subjects are compared with subjects with hypertension and no heart failure (HTN) and subjects with hypertension heart failure and a normal ejection fraction (HFNEF). The normal range for left ventricular internal end-diastolic short-axis diameter (LVIDd) is marked above the graph as mean ± 2 standard deviations (StDevs) for the control group (this encompasses the 95% confidence intervals).
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Figure 2 Gaussian Distribution of LVIDd
Frequency distribution of LVIDd demonstrating that 5% of the control subjects had an LVIDd larger than the upper limits of normal and 15% of the HFNEF subjects had an LVIDd larger than the upper limits of normal. Therefore, only 10% of the HFNEF subjects had an LVIDd larger than expected for the control group. Abbreviations as in Figure 1.
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Figure 3 Schematic Representations of Possible Diastolic Pressure-Volume Relationships in Heart Failure
The normal end-diastolic pressure-volume point is marked as point A. When diastolic pressure increases with little or no change in volume, this indicates a decrease in left ventricular (LV) chamber diastolic distensibility (point A vs. C). However, if both diastolic pressure and volume increase in a coordinate fashion along a normal diastolic pressure-volume relationship, this indicates that LV chamber distensibility has not changed (point A vs. B). However, even in the presence of an increased LV end-diastolic volume (EDV), the LV pressure-volume curve can be displaced upward indicating decreased distensibility (point A vs. D). Thus, an increased LV EDV does not exclude decreased distensibility. Data from the current and previous studies suggest that the vast majority of patients with heart failure and a normal ejection fraction (HFNEF) or diastolic heart failure (DHF) have a diastolic pressure-volume relationship represented by the curve that intersects point C.
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