Combined Ventricular Systolic and Diastolic Dysfunction
It is not uncommon in chronic heart failure to have a combination of both systolic
dysfunction. Therefore, the slope of the end-systolic
(ESPVR) is decreased and the slope of the passive
filling curve (reciprocal of compliance) is increased in the ventricular pressure-volume loop
shown to the right. When this occurs, there is a
dramatic reduction in stroke volume because end-systolic volume is increased and
end-diastolic volume are decreased. Both ejection fraction
and stroke work
are also decreased.
This combination of systolic and diastolic dysfunction, coupled with
compensatory volume expansion, can lead to very high
end-diastolic pressures that can cause pulmonary congestion and edema,
as well as systemic edema and ascites (particularly when the right
ventricle is in failure). Therefore,
are commonly used in these patients.