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To the Editor: The study of systolic and diastolic heart failure (HF) in the community by Dr Bursi and colleagues¹ presents information about the prevalence and prognosis of HF with reduced or preserved left ventricular ejection fraction (EF). However, the authors use the term "diastolic HF" when referring to HF with preserved EF and present HF with preserved and reduced EF as "counterparts." Assigning patients with reduced EF to systolic HF, and those with preserved EF to diastolic HF, overlooks the presence of diastolic dysfunction in patients with reduced EF.

The key element differentiating the 2 types of HF is in the presence or absence of ventricular remodeling, defined as progressive ventricular hypertrophy, enlargement, and cavity distortion over time directly related to deterioration in ventricular performance.² Presence of risk factors such as hypertension or diabetes leads to myocyte apoptosis and necrosis.³ The resultant fibrosis forms the basis of impaired ventricular . . . [Full Text of this Article]

Viorel G. Florea, MD, PhD, ScD
flore022@umn.edu
Department of Medicine
University of Minnesota
Minneapolis

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