Heart failure preserved systolic function

Heart failure can result from any disorder that affects the ability of the heart to contract (systolic function) and/or relax (diastolic dysfunction) common causes of heart failure are shown in Table 14—1 Systolic heart failure is the classic, more familiar form of the disorder, but current estimates suggest that 20% to 50% of patients with heart failure have preserved left ventricular systolic function and suffer from diastolic dysfunction. In contrast to systolic heart failure that is usually caused by previous myocardial infarction (Ml), patients with diastolic heart failure typically are elderly, female, and have hypertension and diabetes. However, systolic and diastolic dysfunction frequently coexist. The common cardiovascular diseases such as MI and hypertension can cause both systolic and diastolic dysfunction thus many patients have heart failure as a result of reduced myocardial contractility and abnormal ventricular filling. 

O Connor AM, Gattis WA, Shaw L, et al. Clinical characteristics and long-term outcomes of patients with heart failure and preserved systolic function. Am J Cardiol 2000 86 863-867. 

Tops et al. recently reported on the development of left ventricular dyssyn-chrony and heart failure symptoms during long term right ventricular pacing following AV junction ablation in 55 patients with preserved systolic function at the time of ablation (59). Patients were followed for 3.8 1.7 years. During follow-up, 27 patients (49%) developed left ventricular dyssynchrony and worsened heart failure symptoms. The New York Heart Association functional class increased from 1.8 0.6 to 2.2 0.7, p < 0.05. The left ventricular ejection... 

Unlike systolic HF, few prospective trials have evaluated the safety and efficacy of various cardiac medications in patients with diastolic HF or preserved ejection fraction. The Candesartan in Heart Failure Assessment of Reduction in Mortality and Morbidity (CHARM) study demonstrated that angiotensin receptor blockade with candesartan resulted in beneficial effects on HF morbidity in patients with preserved LVEF similar to those seen in depressed LV function.25... 

Likewise, heart failure is not always associated with systolic dysfunction and an obvious decline in cardiac pumping ability. In approximately half the cases of symptomatic heart failure, systolic function and cardiac output may appear normal when the patient is at rest.53,63 In this type of heart failure, cardiac function is impaired because the left ventricle is stiff and unable to relax during the filling phase, resulting in increased pressures at the end of diastole.31 This condition is often described as diastolic heart failure, but it is also identified by other names such as heart failure with preserved left ventricular... 

Hogg K, Swedberg K, McMurrayJ. Heart failure with preserved left ventricular systolic function epidemiology, clinical characteristics, and prognosis. J Am Coll Cardiol. 2004 43 317-327. 

The effects of furosemide withdrawal on postprandial blood pressure have been assessed in 20 elderly patients (mean age 73 years) with heart failure and preserved left ventricular systolic function (ejection fraction 61%) (23). In 13 who were able to discontinue furosemide (mean dose 32 mg/day), maximum systolic blood pressure fell significantly from 25 mmHg to 11 mmHg and diastolic blood pressure from 18 to 9 mmHg over 3 months. In the continuation group (mean furosemide dose 21 mg/day), there was no change in the postprandial fall. 

Heart failure (HP) may becausedbya primary abnormality in systolic function, diastolic function, or both. Making the distinction is important because the prevalence, prognosis, and treatment of HP may be quite different depending on whether the predominant mechanism causing the symptoms is systolic or diastolic dysfunction. Some clinical studies have reported that as many as 30% to 50% of patients with congestive heart failure have preserved left ventricular (LV) function, making diastolic heart failure (DHP) very common. In addition, abnormalities in diastolic function also can play an important role in the development of symptoms in patients with cardiomyopathy and systolic heart failure (SHP). 

MacCarthy PA, Kearney MT, Nolan J, et al. Prognosis in heart failure with preserved left ventricular systolic function Prospective cohort study. BMJ 2003 327 78-79. 

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