Systolic versus diastolic dysfunction in heart failure

Pressure-volume loops in normal subjects (in blue) and those with heart failure due to systolic (left panel) or diastolic (right panel) dysfunction. The pressure-volume loop is shifted to the right with systolic dysfunction. The end-diastolic pressure is increased compared with normal (25 versus 10 mmHg in this example), but at a higher ventricular volume and lower ejection fraction. In contrast, the pressure-volume loop is shifted to the left with isolated diastolic dysfunction. Contractility is normal in this setting, but the increase in ventricular stiffness results in an elevated end-diastolic pressure at a lower left ventricular volume.