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Understanding diastolic heart failure

Tan, Yu Ting (2013)
Ph.D. thesis, University of Birmingham.

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Many patients who present with symptoms of heart failure are found to have a normal left ventricular ejection fraction and therefore were labelled as having “diastolic heart failure” implying that the underlying pathophysiology is due to diastolic dysfunction alone. However, using a combination of echocardiographical techniques, a variety of abnormalities were found including reduced longitudinal function, impaired left ventricular twist and torsional dyssynchrony in systole leading to reduced and delayed untwisting, impaired suction and reduced early diastolic left ventricular filling not fully compensated for in late diastole due to left atrial dysfunction. Furthermore in a group of subjects with treated hypertension, the most common risk factor for this form of heart failure, despite a normal resting echocardiogram, there were already substantial abnormalities of both systolic and diastolic function which were only apparent on exercise. Thus these studies have demonstrated that in heart failure with a normal ejection fraction, there are major abnormalities of systolic function especially torsion or twist, which impact on diastolic filling and that the condition is not due to diastolic dysfunction alone. In addition, these findings emphasise the importance of exercise echocardiography for diagnosis and detecting early left ventricular dysfunction before patients progress to developing heart failure.

Type of Work:Ph.D. thesis.
Supervisor(s):Sanderson, John and Leyva, Francisco
School/Faculty:Colleges (2008 onwards) > College of Medical & Dental Sciences
Department:School of Clinical and Experimental Medicine, Department of Cardiovascular Medicine
Subjects:R Medicine (General)
RC Internal medicine
Institution:University of Birmingham
ID Code:4392
This unpublished thesis/dissertation is copyright of the author and/or third parties. The intellectual property rights of the author or third parties in respect of this work are as defined by The Copyright Designs and Patents Act 1988 or as modified by any successor legislation. Any use made of information contained in this thesis/dissertation must be in accordance with that legislation and must be properly acknowledged. Further distribution or reproduction in any format is prohibited without the permission of the copyright holder.
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