title: Combined systolic and diastolic dysfunction in the presence of preserved left ventricular ejection fraction.
abstract: BACKGROUND
  Heart failure with preserved left ventricular ejection fraction (LVEF) suggests isolated diastolic dysfunction.
  
  
  OBJECTIVE
  The purpose of this study was to determine if systolic and diastolic dysfunction occurred with preserved LVEF.
  
  
  METHODS
  Equilibrium resting radionuclide ventriculograms from 439 patients with an LVEF >/=0.50 were used to determine LV peak filling rate (PFR) and peak ejection rate (PER) in end-diastolic volumes per second and LV end-systolic volume (ml). Patients with low-normal (n=147; range, 0.50-0.58; mean+/-S.D., 0.53+/-0.02), intermediate-normal (161, 0.59-0.64, 0.61+/-0.02), and high-normal (131, 0.65-0.94, 0.72+/-0.06) LVEF were compared.
  
  
  RESULTS
  From low-normal to intermediate-normal to high-normal LVEF, LV end-systolic volume decreased (93+/-36, 71+/-33, 43+/-26, respectively, P<0.0001), PFR increased (2.31+/-0.74, 2.58+/-0.74, 3.15+/-0.94, P<0.0001), PER increased (-2.78+/-0.50, -3.13+/-0.47, -3.83+/-0.84, P<0.0001), the percentages of patients with abnormal PFR decreased (66, 56, 40, P<.0001), and the percentage with abnormal PER decreased (47, 14, 5, P<0.0001). Of 193 patients with preserved LVEF and abnormally low PFR, 65 (34%) had abnormally low PER.
  
  
  CONCLUSIONS
  The results indicate that a preserved LVEF was often associated with LV systolic dysfunction (enlarged LV end-systolic volume and low PER) and LV diastolic dysfunction (decreased PFR).
authors.affiliation: Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States. lovejoy.margery@mayo.edu
authors.forename: Ian P
authors.initials: IP
authors.lastname: Clements
mesh_terms: D000368:Aged; D003971:Diastole / Q000502:physiology; D005260:Female; D015637:Gated Blood-Pool Imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013318:Stroke Volume; D013599:Systole / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology*