The pathophysiology of diastolic heart failure

Whilst resting disturbances of both diastolic and long-axis systolic function are observed in patients with heart failure who have normal left ventricular ejection fraction, recent evidence suggests that dynamic disturbances in cardiac function occur during exercise. A paradoxical slowing of left ventricular active relaxation during exercise limits cardiac filling and therefore stroke volume and appears to be due to the combination of cardiac energetic impairment and disturbed ventricular-vascular coupling.