1. Diastolic heart failure
Up to a third of patients have clinical heart failure with normal LV systolic function
Underlying pathophysiology relates to diastolic dysfunction
Commonest underlying pathologies
Normal ageing
Hypertension
Myocardial ischaemia

2. Mechanisms of diastolic dysfunction
Impaired ventricular relaxation
Energy dependent process
Susceptible to myocardial ischaemia
Decreased myocardial compliance
Altered compliance mediated by collagen
Fibrosis related to activation of RAAS

3. Echocardiographic assessment
2D echo to assess systolic function
Doppler echo
Transmitral flow
E/A wave ratio
E wave deceleration time
IVRT

4. Area-length method for calculation of LV mass
LVmass=1.05[5/6(A1xL1)-5/6(A2xL2)]
Divide by body surface area to get LV mass index
Reichek et al. Circulation 1983;67:348-52

6. Doppler patterns of diastolic dysfunction
Impaired relaxation
Reduced E/A ratio
Increased EDT
Increased IVRT
Restriction
LA pressure increases due to myocardial stiffness
High peak E wave velocity
Short EDT
Very short IVRT

10. Treatment of diastolic heart failure
Treat underlying cause eg ischaemia
Impaired relaxation
Theoretically rate-limiting agents effective
Beta-blockers, verapamil
Reduce HR and prolong diastole
Reduce myocardial oxygen demand
Lower BP and reduce LVH

11. Treatment of diastolic heart failure
Restriction
Drugs which reduce fibrosis and lower LA pressure theoretically should be effective
ACEI
AII blockers
Diuretics
If LA pressure lowered too much cardiac output significantly worsened
Can cause significant morbidity

13. Colour Doppler Tissue Imaging

14. Colour Doppler Tissue Imaging

15. Figure 1. Pulsed wave Doppler sample of basal septum of normal subject
S wave
A wave
E wave

16. Figure 2. Pulsed wave Doppler sample of basal inferior wall of subject with previous inferior myocardial infarction due to right coronary artery occlusion.
S wave
E wave
A wave