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.
K. Jane Grande-Allen, Ph.D.
Department of Bioengineering, Rice University, Houston, Texas grande@rice.