Heart Failure With Preserved Left Ventricular Function: Diagnostic and Therapeutic Challenges in Patients With Diastolic Heart Failure Michael N. Young,

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Heart Failure With Preserved Left Ventricular Function: Diagnostic and Therapeutic Challenges in Patients With Diastolic Heart Failure Michael N. Young, MD The American Journal of the Medical Sciences Volume 344, Issue 5, Pages 399-405 (November 2012) DOI: 10.1097/MAJ.0b013e318246d885 Copyright © 2012 Southern Society for Clinical Investigation Terms and Conditions

Figure 1 Electrocardiogram on hospital admission that shows sinus tachycardia, ST-T depression inferolaterally and poor R wave progression. The American Journal of the Medical Sciences 2012 344, 399-405DOI: (10.1097/MAJ.0b013e318246d885) Copyright © 2012 Southern Society for Clinical Investigation Terms and Conditions

Figure 2 Right heart catheterization 2weeks before admission yielded the hemodynamic measurements below. (A) Right atrial mean pressure was 14mmHg. (B) Right ventricular pressure was 75/15mmHg. (C) Pulmonary artery pressure was 77/35mmHg with a mean pressure of 50mmHg. (D) The mean pulmonary capillary wedge pressure was 24mmHg. The American Journal of the Medical Sciences 2012 344, 399-405DOI: (10.1097/MAJ.0b013e318246d885) Copyright © 2012 Southern Society for Clinical Investigation Terms and Conditions

Figure 3 The end-expiratory left ventricular end-diastolic pressure measured on catheterization was significantly increased at 40mmHg (arrow). The American Journal of the Medical Sciences 2012 344, 399-405DOI: (10.1097/MAJ.0b013e318246d885) Copyright © 2012 Southern Society for Clinical Investigation Terms and Conditions

Figure 4 (Top) Transmitral Doppler echocardiography shows a peak transmitral inflow velocity of 1.1 m/sec during early filling (E, white arrowhead) and 1.4 m/sec during late filling (A, boxed arrowhead) of the left ventricle. This E/A pattern is consistent with impaired ventricular relaxation. (Bottom) Tissue Doppler echocardiography reveals a mitral annular velocity of 7.0cm/sec during early filling (e’, white arrow) and 9.0cm/sec during late filling (a’, boxed arrow). Her E/e’ ratio of 15.7 and pseudonormal filling pattern based on this modality suggest a more advanced stage of diastolic dysfunction. The American Journal of the Medical Sciences 2012 344, 399-405DOI: (10.1097/MAJ.0b013e318246d885) Copyright © 2012 Southern Society for Clinical Investigation Terms and Conditions

Figure 5 Representative left atrial pressure recordings in a patient with diastolic heart failure. The American Journal of the Medical Sciences 2012 344, 399-405DOI: (10.1097/MAJ.0b013e318246d885) Copyright © 2012 Southern Society for Clinical Investigation Terms and Conditions

The American Journal of the Medical Sciences 2012 344, 399-405DOI: (10 The American Journal of the Medical Sciences 2012 344, 399-405DOI: (10.1097/MAJ.0b013e318246d885) Copyright © 2012 Southern Society for Clinical Investigation Terms and Conditions