DYSSYNCHRONY IN DIASTOLIC HEART FAILURE
S.F. Nagueh
Methodist De Bakery Heart and Vascular Institute, TX, USA

Few observational studies have shown that systolic dyssynchrony occurs in around a third of patients with diastolic heart failure (DHF). In comparison with DHF patients without dyssynchrony, those with systolic dyssynchrony have a lower ejection fraction, reduced mid wall fractional shortening, and lower stroke work. Diastolic dysfunction as assessed by mean wedge pressure and the time constant of left ventricular (LV) relaxation is also significantly worse in the presence of systolic dyssynchrony.On the other hand, diastolic dyssynchrony has a higher prevalence and occurs in 50-60%. Diastolic dyssynchrony is associated with a worse degree of diastolic dysfunction when compared with DHF patients without diastolic dyssynchrony.  It is also significantly related to LV mass, such that patients with a higher LV mass have a more advanced degree of diastolic dyssynchrony. However, LV systolic properties are preserved. Medical therapy with drugs that decrease systemic blood pressure and after load results in a significant shortening of the diastolic intraventricular time delay which in turn is closely coupled to the improvement in LV diastolic function.