Systolic/Diastolic Heart Failure

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Systolic/Diastolic HF

Several publications note the usefulness of applying the Pressure-Volume catheter technique to the diagnosis of Systolic and Diastolic heart failure (i.e. heart failure with normal ejection fraction (HFNEF)). Westermann et al most recently demonstrated this by diagnosing 90 patients with CD Leycom's pressure-volume technology. Kitzman referred to it as "state-of-the art".

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1	In HFNEF, frequency-dependent upregulation of cardiac output is blunted. This results from progressive volume uploading of the left ventricle due to limited relaxation reserve in combination with increased LV passive stiffness.. (Leycom's PV loops) Wachter R et al. Blunted frequency-dependent upregulation of cardiac output is related to impaired relaxation in diastolic heart failure. Eur Heart J. 2009 Dec;30(24):3027-36.
2	Because of these persistent shortcomings, clinicians should continue to make critical use of current Doppler echocardiographic estimates of LV filling pressures and should not hesitate to implement invasive [pressure-volume] investigations... Tschöpe C, Paulus WJ. Is echocardiographic evaluation of diastolic function useful in determining clinical care? Doppler echocardiography yields dubious estimates of left ventricular diastolic pressures. Circulation. 2009 Sep 1;120(9):810-20; discussion 820.
3	The first approach is the gold standard for LV stiffness measurements and can be obtained only at cardiac catheterization with conductance catheters... Tschöpe C, Paulus WJ. Is echocardiographic evaluation of diastolic function useful in determining clinical care? Doppler echocardiography yields dubious estimates of left ventricular diastolic pressures. Circulation. 2009 Sep 1;120(9):810-20; discussion 820.
4	Online PV loop assessment during primary PCI showed that coronary reperfusion caused an immediate improvement in diastolic function by increasing LV compliance and in systolic function by increasing apical contractility in STEMI patients. Remmelink et al. Accute Left Ventricular Dynamic Effects of Primary Percutaneous Cornonary Intervention. J Am Coll Cardiol 2009; 53:1498-502
5	CD Leycom’s left ventricular pressure-volume analysis technique was used before during and after PTSMA in HOCM patients and demonstrated improved diastolic properties. Meliga E, et al. Effects of percutaneous transluminal septal myocardial ablation for obstructive hypertrophic cardiomypathy on systolic and diastolic left ventricular function assessed by pressure-volume loops. Am J Cardiol 2008;101:1179-1184.
6	PTSMA acutely reduced systolic function but promptly improved diastolic function maintaining hemodynamics as was revealed by Leycom’s pressure-volume analysis technique. Steendijk P, et al. Acute effects of alcohol ablation on systolic and diastolic left ventricular function in patients with hypertrophic obstructive cardiomyopathy. Heart 2008;94:1318-22.
7	The first clinical pressure-volume loop study to demonstrate novel working mechanisms in patients with HFNEF. Westermann D, et al. Role of left ventricular stiffness in heart failure with normal ejection fraction. Circulation. 2008;11:2051-2060.
8	The pressure-volume technique is referred to as state-of-the art. Kitzman D.W. Circulation. 2008; 11:2044-2046. Editorial
9	"Doppler-derived indexes of ventricular filling don’t provide specific information on intrinsic passive diastolic properties.” Maurer MS, Spevack D, Burkhoff D, Kronzon I. Diastolic dysfunction: can it be diagnosed by Doppler echocardiography? J Am Coll Cardiol. 2004 Oct 19;44(8):1543-9.
10	"After decades of study, there is little agreement as to the utility of echocardiographic-Doppler indexes of LV diastolic function in the diagnosis of diastolic heart failure.” Zile MR, Brutsaert DL. New concepts in diastolic dysfunction and diastolic heart failure. Part I: diagnosis, prognosis, and measurements of diastolic function. Circulation. 2002 Mar 19;105(11):1387-93.
11	The left ventricular pressure-volume relationship has been used to examine ventricular systolic and diastolic function as well as to evaluate myocardial energetics and ventricular-vascular coupling. "Indices of function can be examined on-line..." Cassidy SC. Pressure-volume relationships in pediatric systolic and diastolic heart failure. Prog Pediatr Cardiol. 2000 Sep 1;11(3):211-218.
12	“It is now clear that the majority of patients with what is currently called “systolic heart failure” also have diastolic dysfunction of various degrees.” Grossman W. Defining diastolic dysfunction. Circulation. 2000 May 2;101(17):2020-1.
13	"Definitive objective evidence of ventricular diastolic dysfunction requires cardiac catheterization. ..... demonstrating an increased LV end-diastolic filling pressure in the presence of a normal or reduced LV end-diastolic volume." Vasan RS, Levy D. National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA 01702, USA. Circulation. 2000 May 2;101(17):2118-21.

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