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.
" />

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.
"> Author Profile – Methodist Journal
Methodist Journal

IN THIS ISSUE

Venous Interventions

Vol 14, Issue 3 (2018)


FEATURED GUEST EDITOR

ISSUE INTRO

It’s Time We Reassess Our Primitive Understanding of the Venous System

See More
RECOGNITIONS

Jean Bismuth Spearheads Issue on Venous Interventions

See More

REVIEW ARTICLES See More

Central Venous Pathologies: Treatments and Economic Impact

Venous Thrombosis and Post-Thrombotic Syndrome: From Novel Biomarkers to Biology

Mechanical Properties of Diseased Veins

Use of Computed Tomography and Magnetic Resonance Imaging in Central Venous Disease

Application of Intravascular Ultrasound in End-Stage Renal Patients with Central Venous Occlusive Disease

Intraoperative Imaging and Image Fusion for Venous Interventions

Endovascular Treatment for Venous Diseases: Where are the Venous Stents?

Endovascular Therapy for Central Venous Thrombosis

CASE REPORTS See More

Immune Checkpoint Inhibitor Related Cardiotoxicity

Tyrosine Kinase Inhibitor-Induced Acute Myocarditis, Myositis, and Cardiogenic Shock

Primary Nonbacterial Thrombotic Endocarditis Presenting with Bowel Infarction Secondary to Superior Mesenteric Artery Embolism

Persistent Left Superior Vena Cava with Absent Right Superior Vena Cava

MUSEUM OF HMH MULTIMODALITY IMAGING CENTER See More

Incision and Drainage of a Forgotten Vascular Graft

CLINICAL PERSPECTIVES See More

EXCERPTA

Telemedicine Shakes Up the ICU Experience

POINTS TO REMEMBER

Venous Thrombosis in Nephrotic Syndrome

EXCERPTA

Heartsick: Medical and Ethical Challenges of Infective Endocarditis in the Opioid Epidemic

EXCERPTA

Redefining “Worth It” for CTO PCI

EDITORIALS

Letter to the Editor