The role of systolic–diastolic coupling in distinguishing impaired diastolic recoil in healthy aging and heart failure with preserved ejection fraction

Background Age‐related changes to left ventricular (LV) early diastolic recoil confound the diagnostic value of e′ velocity in heart failure with preserved ejection fraction (HFpEF). Systolic–diastolic coupling quantifies passive left ventricular elastic recoil and may be superior to e′ in differentiating abnormal diastolic recoil in HFpEF from healthy aging. This study aims to determine the effect of healthy aging and HFpEF on systolic–diastolic coupling. Methods Healthy adults (n = 141, aged 20‐90 years) underwent right heart catheterization (RHC) to quantify LV filling pressure and tissue Doppler echocardiography to define peak velocities and excursion (velocity time integral) of the mitral annulus. Separately, HFpEF patients (n = 12, age 67 ± 5 years) and controls (n = 12, age 68 ± 5 years) underwent RHC and echocardiography. Systolic–diastolic coupling was measured as early diastolic excursion (ED exc ) divided by systolic excursion (S exc ). Results In healthy adults, ED exc / S exc declined by 15% per decade of life ( r 2 = 0.53, P < .001). ED exc /S exc was significantly lower in HFpEF compared with controls (0.43 ± 0.11 vs 0.56 ± 0.11, P = .011), while e′ was similar (6.2 ± 1.5 vs 6.8 ± 1.3 cm/s, P = .33). Using ROC analysis, ED exc /S exc had an AUC to detect HFpEF of 0.82 (0.61‐0.95, P = .007), which was superior to e′ alone (AUC 0.60(0.39‐0.80), P = .39; P = .026 for difference). Conclusions Systolic–diastolic coupling, quantified by the ED exc /S exc ratio, declined linearly with healthy aging. The ED exc /S exc ratio was further reduced in HFpEF and able to predict HFpEF more accurately than e′ alone. Systolic–diastolic coupling may be a useful diagnostic tool to detect HFpEF.