<icirculation>:
Can you have heart failure symptoms， even though there is no evidence of diastolic dysfunction?

Sanderson
Yes， that is technically possible.  One of the best measures of diastolic dysfunction is left atrial volume.  We have seen patients who have completely normal echo cardiograms at rest， but when you exercise them and you do slightly more sophisticated measurements such as long-axis function and strain and torsion， and they are clearly abnormal.   In fact， we have a publication coming out in Heart  journal in which a group of hypertension patients who had no LVH and completely normal echoes at rest， but were breathless， had significant abnormalities of ventricular function on exercise.   So it is possible to be breathless due to cardiac dysfunction， but have a normal echocardiogram at rest.