title: Isolated left ventricular diastolic dysfunction: implications for exercise left ventricular performance in patients without congestive heart failure.
abstract: OBJECTIVE
  Clinical relevance of left ventricular (LV) diastolic dysfunction in the absence of congestive heart failure (CHF) and LV systolic dysfunction is not fully established.
  
  
  METHODS
  Asymptomatic outpatients, sedentary, with cardiovascular risk factors but no history of cardiovascular events, underwent echocardiographic evaluation of LV structure and function by standard Doppler, color M-mode, and Doppler tissue methods, and exercise testing with simultaneous noninvasive assessment of LV stroke index and cardiac index. LV ejection fraction less than 50% and significant valvular disease or stress test suggestive of coronary disease were additional exclusion criteria.
  
  
  RESULTS
  In 70 patients selected (40 +/- 10 years old, 63% men, 34% hypertensive, 34% diabetic, 4% diabetic and hypertensive, 11% with LV hypertrophy), LV diastolic dysfunction was detected in 26%, which was associated with hypertension, higher LV mass index, lower systolic function, lower peak exercise heart rate, and chronotropic reserve (all P < .05), and with lower peak exercise stroke index and cardiac index (both covariates adjusted P < .05), but not with lower peak exercise metabolic equivalents (P > .5). Abnormal LV relaxation was independently correlated with lower peak exercise cardiac index and stroke index (both P < .05). Peak exercise systolic and cardiac indices were comparable between patients with CHF risk factors (74%) versus those without.
  
  
  CONCLUSIONS
  Isolated LV diastolic dysfunction was independently associated with lower peak exercise LV systolic performance in patients without CHF. Its diagnosis may provide a target for aggressive CHF risk management.
authors.affiliation: Department of Clinical and Experimental Medicine, Federico II University of Naples, Naples, Italy. vpalmier@med.cornell.edu
authors.forename: Vittorio
authors.initials: V
authors.lastname: Palmieri
authors.forename: Cesare
authors.initials: C
authors.lastname: Russo
authors.forename: Emiliano A
authors.initials: EA
authors.lastname: Palmieri
authors.forename: Emma
authors.initials: E
authors.lastname: Arezzi
authors.forename: Salvatore
authors.initials: S
authors.lastname: Pezzullo
authors.forename: Stefana
authors.initials: S
authors.lastname: Minichiello
authors.forename: Stefania
authors.initials: S
authors.lastname: Martino
authors.forename: Paola
authors.initials: P
authors.lastname: Migliaresi
authors.forename: Aldo
authors.initials: A
authors.lastname: Celentano
mesh_terms: D000328:Adult; D000368:Aged; D003971:Diastole; D005080:Exercise Test / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging*