Contractile Behavior of the Left Ventricle in Diastolic Heart Failure

2]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. 46]789 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. Structural RemodelingThe hearts of patients with systolic heart failure differ dramatically from those of patients with diastolic heart failure in regard to both gross and microscopic anatomic features.As will be seen, these anatomic differences tend to parallel physiological and functional differences in systolic and diastolic heart failure 10,11 (Table 1).