DIASTOLIC DYSFUNCTION IN ELDERLY PATIENTS WITH DYSPNEA AND NORMAL LEFT-VENTRICULAR SYSTOLIC FUNCTION

Background: Diastolic dysfunction, defined as impaired filling of the ventricles, is a recognized cause of acute cardiac failure. However, i ts role in causing exertional dyspnoea in elderly patients is not clea rly known. This study was undertaken to determine whether a group of e lderly patients with exertional dyspnoea and normal left ventricular s ystolic function had reduced diastolic function compared with a group of elderly control subjects without dyspnoea. Methods: The patient gro up consisted of 32 subjects (mean +/- SD age 73 +/- 5.0 years) with ex ertional dyspnoea, but without respiratory disease or left ventricular systolic dysfunction. The control group consisted of 30 similar subje cts (mean +/- SD age 73 +/- 4.7 years) without dyspnoea. Pulsed Dopple r ultrasound was used to measure the isovolumic relaxation time (IVRT) , peak early (E) and late (A) diastolic transmitral flow velocities, E :A ratio, deceleration time of E and other indices of diastolic functi on. Transthoracic two-dimensional and M-mode echocardiography were use d to assess left ventricular dimension and systolic function. Results: The IVRT was significantly longer in the patient group than in contro ls (116 +/- 24 ms versus 98 +/- 19 ms, P = 0.002). The E:A ratio was s ignificantly lower in patients than in controls (0.63 +/- 0.14 versus 0.75 +/- 0.17, P = 0.004). These differences could not be explained on the basis of any other patient characteristics. Conclusions: Elderly patients with exertional dyspnoea and normal left ventricular systolic function had reduced diastolic function compared with controls. Diast olic function should be routinely assessed in elderly patients who are referred for echocardiography to investigate suspected cardiac failur e.