Heart failure with a normal ejection fraction.

To the Editor: In a recently published article in Circulation , Dr Zile and colleagues1 evaluated patients with a history of heart failure (HF) and a normal left ventricular (LV) systolic function. Invasive hemodynamic and/or Doppler echocardiographic indices of LV filling were abnormal in all patients, suggesting that diastolic HF can be diagnosed without the need for objective evidence of LV diastolic dysfunction. The hemodynamic correlate of pulmonary congestive symptoms is elevated pulmonary capillary pressure (PCP) (or mean left atrial [LA] pressure). Impaired LV relaxation, by itself, is not necessarily associated with elevated LA pressure. By LV catheterization, mean LA pressure is better predicted by preA pressure than by LV end-diastolic pressure,2 the focus of the current analysis. In fact, LV end-diastolic pressures are frequently elevated in hypertrophic ventricles without elevation of mean LA pressures. Although, on average, preA pressures were elevated in this study (16±8 mm Hg), obviously many patients had preA pressures that were not elevated and, therefore, not explanatory of HF symptoms. …