In 1971, I was a cardiology fellow working at Baylor College of Medicine with Dr. William Gaasch, who was interested in the evaluation of cardiac function and LV compliance. Practicing in a county hospital, we saw a good number of patients with chronic pressure overload lesions such as hypertension and aortic stenosis who presented with a congestive state (dyspnea, high PCWP) but with normal LV dimensions and fractional shortening by echocardiography. This prompted us to do a series of studies evaluating the LV pressure-volume properties in these patients and compare them to patients with dilated cardiomyopathy.1 Our studies were subsequently followed by a large volume of clinical and basic investigations that clearly demonstrated the presence of abnormalities (relaxation, LV diastolic stiffness) in patients presenting with the clinical syndrome of “heart failure” and normal LVEF. In 1988, Kessler introduced the term “diastolic heart failure” to describe a group of patients with a congestive state characterized by normal or near-normal LVEF and absence of progressive LV dilatation.2 By contrast, “systolic heart failure” referred to heart failure associated with dilated left ventricles and depressed EF. This review will cover the issues concerning the use of this terminology and discuss some of the pathophysiologic mechanisms currently in vogue to explain the occurrence of heart failure in the presence of normal systolic pump function.

With the advent of cardiac angiography over 40 years ago, ejection fraction (EF) emerged as the preferred index of left ventricular (LV) systolic performance. Despite its limitations, LVEF has stood the test of time as an indicator of the LV pumping function and allows separation of patients with myocardial dysfunction into grades of severity that predict different clinical outcomes. As echocardiography and radionuclide angiography became widely available, LVEF became the single most commonly used indicator of cardiac performance.
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In 1971, I was a cardiology fellow working at Baylor College of Medicine with Dr. William Gaasch, who was interested in the evaluation of cardiac function and LV compliance. Practicing in a county hospital, we saw a good number of patients with chronic pressure overload lesions such as hypertension and aortic stenosis who presented with a congestive state (dyspnea, high PCWP) but with normal LV dimensions and fractional shortening by echocardiography. This prompted us to do a series of studies evaluating the LV pressure-volume properties in these patients and compare them to patients with dilated cardiomyopathy.1 Our studies were subsequently followed by a large volume of clinical and basic investigations that clearly demonstrated the presence of abnormalities (relaxation, LV diastolic stiffness) in patients presenting with the clinical syndrome of “heart failure” and normal LVEF. In 1988, Kessler introduced the term “diastolic heart failure” to describe a group of patients with a congestive state characterized by normal or near-normal LVEF and absence of progressive LV dilatation.2 By contrast, “systolic heart failure” referred to heart failure associated with dilated left ventricles and depressed EF. This review will cover the issues concerning the use of this terminology and discuss some of the pathophysiologic mechanisms currently in vogue to explain the occurrence of heart failure in the presence of normal systolic pump function.

With the advent of cardiac angiography over 40 years ago, ejection fraction (EF) emerged as the preferred index of left ventricular (LV) systolic performance. Despite its limitations, LVEF has stood the test of time as an indicator of the LV pumping function and allows separation of patients with myocardial dysfunction into grades of severity that predict different clinical outcomes. As echocardiography and radionuclide angiography became widely available, LVEF became the single most commonly used indicator of cardiac performance.
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Methodist Journal

IN THIS ISSUE

Lipids and Lipoproteins

Vol 15, Issue 1 (2019)


FEATURED GUEST EDITOR

ISSUE INTRO

Lipids and Cardiovascular Disease: Putting it All Together

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RECOGNITIONS

Guest Editors Henry Pownall and Antonio Gotto Offer Insight and Expertise on the topic of Lipids and Cardiovascular Disease

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REVIEW ARTICLES See More

Cholesterol: Can’t Live With It, Can’t Live Without It

How Much Do Lipid Guidelines Help the Clinician? Reading Between the (Guide)lines

Statins: Then and Now

Poststatin Lipid Therapeutics: A Review

HDL and Reverse Cholesterol Transport Biomarkers

Revisiting Reverse Cholesterol Transport in the Context of High-Density Lipoprotein Free Cholesterol Bioavailability

High-Density Lipoprotein Subspecies in Health and Human Disease: Focus on Type 2 Diabetes

Gene Delivery in Lipid Research and Therapies

CASE REPORTS See More

Device-Related Thrombus: A Reason for Concern?

Retained Coronary Balloon Requiring Emergent Open Surgical Retrieval: An Uncommon Complication Requiring Individualized Management Strategies

Loperamide Mimicking Brugada Pattern

Reversed Pulsus Paradoxus in Right Ventricular Failure

MUSEUM OF HMH MULTIMODALITY IMAGING CENTER See More

Transcatheter Embolization of a Persistent Vertical Vein: A Rare Cause of Left-to-Right Shunt and Right-Sided Heart Failure

CLINICAL PERSPECTIVES See More

EXCERPTA

Talking Statins with Antonio Gotto

POINTS TO REMEMBER

Lipids and Renal Disease

EXCERPTA

Addressing the Feedback Loop Between Depression, Diabetes, and Cardiovascular Disease

POINTS TO REMEMBER

The Kidney as an Endocrine Organ

EDITORIALS

Addressing the Underrepresentation of Women in Cardiology through Tangible Opportunities for Mentorship and Leadership