Letter by Sanderson regarding article "Contractile behavior of the left ventricle in diastolic heart failure: with emphasis on regional systolic function".

In diastolic heart failure, the left ventricular (LV) ejection fraction (EF) is normal and there is increased passive stiffness with impaired relaxation of the ventricle, resulting in disturbances in the pattern of filling and elevated diastolic pressure.1–3 The mechanism underlying such failure has been thought to be principally diastolic because LV diastolic function is universally abnormal and systolic performance, function, and contractility are normal.4 However, several reports suggest that abnormalities in regional shortening are present in diastolic heart failure.5–9 The significance of these findings, especially their relation to the syndrome of heart failure, remains uncertain. Accordingly, we will review some of the structural and functional differences between systolic and diastolic heart failure, and, emphasizing the systolic or contractile behavior of the left ventricle, we will attempt to reconcile what appear to be disparate conclusions about LV systolic function in patients with diastolic heart failure.