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 (r² = 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.