CORRESPONDENCE: LETTER TO THE EDITOR
Diastolic Dysfunction and Doppler Echocardiography
John E. Sanderson, MD, FACC*
* Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong S.A.R. (Email: jesanderson{at}cuhk.edu.hk).
The recent review by Maurer et al. (1) on diastolic dysfunction was a welcome read. I concur completely with their observations that "have led us to fundamentally question whether diastolic dysfunction is the underlying pathologic mechanism of the heart failure syndrome in all hypertensive patients with "heart failure with a normal ejection fraction" (HFNEF)." Our group has also come to the same conclusion. We showed some time ago that systolic function is not normal in patients with "diastolic heart failure" or HFNEF when more sensitive measures of left ventricular long axis function are made by tissue Doppler recording of the mitral valve annulus (2). These findings have now been confirmed by others.
We also found that early diastolic filling velocities are closely related to those of systole (3), supporting the view that the most important determinant of early diastolic filling is in fact the previous systole. The Torrent-Guasp concept of ventricular contraction (4) provides an elegant explanation for why systole is so closely related to early diastolic filling because the latter is in fact a systolic phenomenon. Perhaps what was missing in this review was the concept of ventricular suction, which drives early diastolic filling, and the role that ventricular twisting and untwisting has in this. Loss of this normal twisting motion may play an important part in the abnormal diastolic filling found in HFNEF. Thus, the problem in HFNEF clearly does not reside in diastole alone, and the term "diastolic heart failure" has become meaningless (5).
Finally, it is surprising that work that relies almost entirely on passive measurements of ventricular stiffness at the end of diastole (6) without any sophisticated assessment of systolic or early diastolic function can still be used to support the obsolete concept of "diastolic heart failure."
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References
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1. Maurer MS, Spevack D, Burkhoff D. Diastolic dysfunction. Can it be diagnosed by Doppler echocardiography? J Am Coll Cardiol 2004;44:1543-1549.[Abstract/Free Full Text]
2. Yip GW, Wang M, Zhang Y, Fung JWH, Ho PY, Sanderson JE. Left ventricular long axis function in diastolic heart failure is reduced in both diastole and systoletime for a redefinition?. Heart 2002;87:121-125.[Abstract/Free Full Text]
3. Yip GW, Zhang Y, Tan PY. Left ventricular long axis function changes in early diastole and systoleimpact of systolic function on diastole. Clin Sci 2002;102:515-522.[Medline]
4. Torrent-Guasp F, Kocica MJ, Corno A. Systolic ventricular filling Eur J Cardiovasc Surg 2004;25:376-386.
5. Sanderson JE. Diastolic heart failurefact or fiction?. Heart 2003;89:1281-1282.[Free Full Text]
6. Zile MR, Baicu CF, Gaasch WH. Diastolic heart failure—abnormalities of active relaxation and passive stiffness N Engl J Med 2004;350:1953-1959.[CrossRef][Web of Science][Medline]
Related Article
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- Mathew Maurer, Daniel Spevack, Daniel Burkhoff, and Itzhak Kronzon
J. Am. Coll. Cardiol. 2005 45: 2095.
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