True or False: Patients with left-sided diastolic dysfunction heart failure usually have a normal ejection fraction.

• A. True
• B. False
• C. Not sure
• D. Not applicable

Answer: (A)

Left-sided diastolic dysfunction causing heart failure is usually heart failure with preserved ejection fraction. The ejection fraction is a measure of systolic pumping, not filling. In diastolic dysfunction, the ventricle is stiff and has trouble relaxing to fill properly, which raises filling pressures and causes congestion, but the heart can still eject a normal proportion of the blood it holds. Therefore the ejection fraction typically remains normal (often defined as around 50% or higher). This is in contrast to systolic heart failure, where the pumping ability is reduced and the ejection fraction is low. If someone thought it was false, they’d be conflating diastolic problems with reduced systolic function.