Systolic and Diastolic Myocardial Mechanics in Patients with Cardiac Disease and Preserved Ejection Fraction: Impact of Left Ventricular Filling Pressure

Background: There are few data on the impact of left ventricular (LV) filling pressure on systolic and diastolic myocardial mechanics in patients with cardiac disease and preserved LV ejection fraction (LVEF) (>= 50%). Methods: Patients referred for cardiac catheterization underwent comprehensive echocardiography within 20 minutes of catheterization. Strain and strain rate in longitudinal, radial, and circumferential directions and torsion were measured in systole and diastole. LV preatrial contraction pressure (pre-A) was measured and averaged over 10 cardiac cycles. Results: Sixty patients were studied (mean age, 55.3 +/- 8.9 years). The 30 patients with LV pre-A >= 15 mm Hg had significantly lower longitudinal systolic strain and radial, circumferential, and torsional systolic strain rates than the 30 patients with LV pre-A < 15 mm Hg (P < .05 for all). Similar findings were seen for diastolic variables. There were significant correlations between several systolic and diastolic variables in multiple directions and LV pre-A. On multivariate analysis, the independent predictors of systolic and diastolic speckle-tracking parameters included LVEF and LV pre-A, depending on the specific parameter analyzed. Conclusions: In patients with preserved LVEF and cardiac disease, several systolic and diastolic myocardial mechanical parameters significantly correlate with LV filling pressure. These data highlight the notion that patients with preserved LVEF and elevated LV filling pressures have significant abnormalities in systolic function as detected by speckle imaging, findings that may challenge the concept of "isolated diastolic dysfunction." The extent of systolic and diastolic abnormalities in these patients may shed light on the mechanics of heart failure with preserved LVEF. (J Am Soc Echocardiogr 2010;23:1273-80.)