Medical examinations of professional and amateur athletes at a sports medicine clinic. Insights from a sports medicine specialist and cardiologist.

In 2019, three regulations of the Minister of Health regarding sports medicine examinations in children, adolescents and young athletes came into force. The publication presents in detail the current scope of tests and the frequency of required medical examinations necessary to obtain medical certificates qualify- ing patients to practice sports. The publication also presents the Regulation of the Minister of Health on the required qualifications of doctors authorized to issue medical certificates to athletes. It is very important to properly assess the health of potential and current athletes to ensure their safety while participating in sports competitions. There are diseases that increase the risk of sudden cardiac death which doctors should keep in mind when qualifying athletes for competition. The publication draws attention to the underestimated role of echocardiography and electrocardiographic stress testing.

Introduction to Clinical Sciences - self-resolving clinical problems in small groups - perception of course participants - pilot study.

B a c k g r o u n d: Problem-based learning is a method of acquiring knowledge and competences on the basis of work on the problem. Medical universities use the PBL method more widely in the course of teaching future physicians, in the CMUJ classes using the PBL method were introduced in the third year of studies, as a part of the Introduction to Clinical Sciences. M e t h o d s: At the end of course, the students voluntarily filled in a questionnaire (17 questions concerning various aspects of the course). A total of 105 questionnaires were analyzed. Statistica 12.0 program was used for this analysis. R e s u l t s: 95.5% of respondents positively perceived the way of conducting classes in the form of PBL and considered them to be in line with their expectations (81%). 80% of respondents confirmed the usefulness of classes in acquiring knowledge and integrity with pre-clinical subjects. Divided opinions were expressed by the respondents as to the benefits and satisfaction from independent presentation and teaching of other students, 34.3% rather emphasized the benefits, while 28.6% expressed a negative opinion. C o n c l u s i o n s: The study confirmed usefulness of classes conducted using the PBL method, both in terms of deepening the knowledge and repetition of already gained knowledge, as well as beneficial reception of classes by students. The course may be modified in the future by increasing the number of cases.

Modification of teaching during the COVID-19 pandemic at the Department of Medical Education of Jagiellonian University Medical College.

The SARS-CoV-2 pandemic contributed to the implementation of changes in the methodology of conducting many courses at medical universities. Achieving learning outcomes was associated with self-discipline and an increased portion of students' independent work. The aim of the study is to analyze the adaptation of teaching methods to the requirements of the COVID-19 pandemic at the Department of Medical Education of Jagiellonian University Medical College. The university authorities, instructors and students made every effort not to neglect their education. The Microsoft Teams platform allowed for the efficient organization of remote classes. Lectures, activities based on dialogue, brainstorming and role-playing were conducted via the Internet. Presentations and short films were made available to students. The safety of individuals participating in classes was guaranteed by password access and an invitation sent prior to an online meeting. Remote learning allowed for the synthesis and deepening of students' knowledge, improvement of communication skills and development of clinical thinking as future doctors. The disadvantages of online education was the inability to improve practical skills, especially on phantoms, under the direct supervision of a trained instructor.

The modified Peyton's approach and students' learning style.

BACKGROUND: The aim of the study was to determine the predominant learning style and type of intelligence based on the VARK questionnaire and Multiple Intelligences Questionnaire respectively in second year medical students. Determining the relationship between individual preferences of students, based on their learning style and predominant type of intelligence and the perception of the modified Peyton's four-step approach used to teach cardiac auscultation. METHODS: The opinion of participants 236 of the modified four-step approach was attained through the use of anonymous questionnaires. Using the VARK questionnaire, the participants' learning style was defined. The predominant type of intelligence was determined by the Multiple Intelligences Questionnaire. RESULTS: The kinesthetic style was the predominant unimodal learning style in second year medical students (in Polish and international students). The most predominant type of intelligence in Polish students was visual-spatial and mathematical and logical, while in international students the predominant types were visual-spatial and mixed type of intelligence. Quantitative analysis indicated that the modified Peyton's approach is a valuable learning and teaching method for most students, independent of their predominant learning style or intelligence type. The exception was a small group of students with linguistic intelligence predominance according to the Multiple Intelligence Questionnaire, for which the Peyton method was more difficult. CONCLUSIONS: This study proves that the modified Peyton's approach is useful and effective didactic tool and can be successfully applied to most students. This is a new learning strategy for teaching cardiac auscultation in laboratory conditions in classes for a significant majority. Due to the fact that a group of students with a predominance of linguistic intelligence more often perceived the Peyton method to be difficult, it is worth combining traditional methods with new ones in class so that all students, regardless of unimodal learning style or prevailing type of intelligence, are taught satisfactorily.

Perceptions of clinical teachers acting as examiners regarding the value of Objective Structured Clinical Examinations.

OBJECTIVES: OSCE (Objective Structured Clinical Examination) is a common method of assessing clinical skills used at many universities. An important and at the same time difficult aspect of good examination preparation is obtaining a properly trained and well-motivated group of assessors. To effectively recruit and maintain cooperation with assessors, it is worth to know their opinion. The aim of this study was to investigate the opinions of teacher-examiners about OSCE and to identify the factors that could shape this opinion and influence on motivation. METHODS: A cross-sectional study was conducted using a questionnaire on teachers who participated as OSCE examiners. This questionnaire consisted of 21 questions about their perceptions. Answers were rated in a five-point Likert-type scale. Chi-square or Fisher's exact test was used to analyze the data. RESULTS: A total of 49 (out of 52) teachers participated in this study. Nearly 90% of examiners believed that it is fair, more than 90% that it is transparent. Despite the fact that 67% of examiners believe the examination is difficult to organize and 71% believe it is stressful for students, according to 72% of respondents the OSCE has a positive effect on learning. More than 91% of examiners believed that the OSCE is an appropriate test to assess students' skills. Opinions about examination were independent of specialty, seniority, gender or taking the OSCE as students. CONCLUSION: Teacher-examiners viewed the OSCE as a fair and transparent examination, adequate for assessment of skills and, despite it being difficult to organize, worth doing as it is appropriate to assess practical skills and positively influences students' motivation to learn tested skills.

The modified Peyton approach in the teaching of cardiac auscultation.

BACKGROUND: The aim of the study was to evaluate the usefulness of the modified Peyton's four-step approach in the teaching of cardiac auscultation and to determine students' perception of Peyton's four-step approach. METHODS: The opinion of the participants on the usefulness of the modified four-step approach was attained through the use of anonymous questionnaires, voluntarily completed by students, and on the basis of semi-structured interviews conducted with a subset of students. 187 second-year students of our 6-year long curriculum were enrolled. They attended an obligatory Laboratory Training of Clinical Skills course. The average group size was 16 students. RESULTS: The survey findings identified that 88.1% of participants found it helpful in developing their understanding of cardiac auscultation. 89.8% of all participants claimed that the new modified four-step approach facilitated memorization. The modified Peyton's four-step method allows for better organization of classes in the opinion of 87.6% students. The advantages of the method were noticed by the majority of students. CONCLUSIONS: The modified Peyton's four-step approach in the teaching of cardiac auscultation under laboratory conditions was perceived by students to be a comprehensible method that facilitates understanding and memorization. This approach allows for improved organization of classes. From the student's perspective this method allows one to master the technique of cardiac auscultation in the classroom, through the increased demand of the participants' attention, activity and involvement.

Implementation of the modified four-step approach method for teaching echocardiography using the FATE protocol-A pilot study.

INTRODUCTION: Peyton's four-step approach is well-known and commonly used in medical education. It is a practical and useful method which is simple to apply. The study presents the implementation of the modified four-step approach method to teach how to perform the emergency echocardiographic assessment according to FATE (Focus-Assessed Transthoracic Echo) protocol. The aim of the study was to determine the feasibility and utility of this method FATE protocol teaching. DESIGN: We collected students' feedback relating to perception of this way of teaching. Based on a semistructured interview conducted with the students, as well as an evaluation of the electronic survey, it has been demonstrated that the four-step method is useful for teaching emergency echocardiographic assessment. SETTING: One Polish medical school. PARTICIPANTS: The classes were run in small groups as part of an elective ultrasound course for the fourth- and fifth-year students of the Faculty of Medicine of the Medical College. Twenty-two students were trained. RESULTS: Based on the opinions of the participants of the elective course and the teacher conducting the classes, which involved the use of the modified Peyton's four-step method in teaching echocardiography in emergency cases according to the FATE protocol, it has been determined that the four-step method is effective in imaging training. All participants claim that this method is clear and understandable. Advantages of the methodological approach: a slow-motion demonstration by the instructor, accompanied by the commentary on the activities undertaken and practical exercises performed by the participants, learning through repetition, requirement of constant concentration. CONCLUSIONS: Peyton's approach allows to use of the class time in maximal extend by consolidating new information and facilitating memorization through adequate instructor guidance and observation of the training of the peer students and repetition of the skills acquired.

Chronic heart failure in the elderly: still a current medical problem.

Congestive heart failure (CHF) is the final stage in several heart diseases. The diagnosis of CHF in older patients is a challenge. Preserved left ventricular systolic function is a characteristic type of CHF in seniors. The purpose of the study was to characterize elderly patients with CHF and to highlight specific features of the conditions in seniors. e most common etiology of HF in this group of patients is hypertension and coronary heart disease. In seniors atypical presentations of chronic heart failure is much more common than in younger patients. Malnutrition, limitations of exercise and sedentary lifestyles or comorbid diseases have an influence on asymptomatic, early stage of HF. There are better outcomes of treatment in obese individuals. It is called the obesity paradox. Open communication with a patient and his/her family may improve their response to therapy. When heart failure becomes an incurable disease and aggressive treatment is ineffective, palliative care should be considered in end-of-life heart failure patients. The goal of treatment in the remaining moments of life last moments of life should be maximizing the patient's comfort.

Trauma-induced acute myocardial infarction due to delayed dissection of the left anterior descending coronary artery.

Acute myocardial infarction is a very rare, life-threatening complication of blunt chest trauma. A 27-year-old man with no previous medical history was admitted to the emergency department due to multiple trauma following a car accident. After 48h following the accident, the patient's condition rapidly deteriorated, with severe dyspnea at rest, tachycardia, and increasing chest pain. A 12-lead ECG showed a sinus tachycardia at 120bpm with significant ST-segment elevation in leads V1 to V5, pathologic Q wave in I, aVL, and QS complex in leads V1 to V4. Bedside echocardiography disclosed akinesis of the anterior and lateral walls, apex, and anterior septum with severely decreased left ventricular ejection fraction of 30%. Urgent coronary angiography revealed an occlusive dissection of the proximal left anterior descending coronary artery. Primary percutaneous coronary intervention with a Biolimus A9™-eluting stent implantation were successfully performed. The further course was uneventful. At 12-month follow-up, the patient has remained asymptomatic with no recurrence of cardiovascular symptoms.

The Objective Structured Clinical Examination (OSCE) from the perspective of 3rd year's medical students - a pilot study.

BACKGROUND: In 2015 Department of Medical Education in Medical College of Jagiellonian University in Cracow performed a new format of integrated multidisciplinary skills assessment of third year students of medicine a er completing initial courses in internal medicine, surgery, pediatrics and gynecology. AIM: OSCE assessed from the perspective of 3rd year medical students. METHODS: Students of 3rd year's study of Faculty of medicine were evaluated by OSCE, which assessed their internal medicine, surgery, gynecology, pediatric skills. OSCE consisted of 12 stations. In order to assess student's opinions on OSCE, we used method of diagnostic survey; Statistica 12.0. RESULTS: OSCE passed 255 (98.83%) of the students in thefirst term. We analyzed 221 questionnaires, in which students expressed their opinion. 93.7% of the students considered OSCE as a well organized exam. 87.8% of students claimed that OSCE is fair and 95.5% that the exam is clear. 86.4% students are pleased with the introduction information about OSCE that was given before the examination. 78.6% students believe, that OSCE allows to properly identify skills that require improvement. Students, who didn't pass all stations with positive result, more o en (Chi^2 Pearsona, p = 0.01990) indicated improper balance between quantity of stations that check communication skills and these checking other clinical skills. CONCLUSIONS: is study confirms that OSCE in the students' opinions was well organized and fair. It proves that OSCE correctly selects students who need to improve their knowledge and skills. Students' preparing to the exams, their knowledge and skills, influences on the students' perception of OSCE.

Prognostic factors of left ventricle function deterioration in patients with coronary disease and normal results of echocardiographic examination in a 2-year observation - prospective cohort study.

INTRODUCTION: Coronary disease is one of the strongest risk factors of developing heart failure. Identification of the predictive factors of left ventricle (LV) function deterioration in patients with stable angina pectoris and normal systolic function of LV, is a challenge for clinicians. OBJECTIVE: Identification of prognostic factors: clinical, echocardiographic, biochemical (NT-proBNP, hsCRP) and spiroergometric of left ventricle function deterioration in patients with coronary disease and normal results of baseline echocardiographic examination in a 2-year observation. PATIENTS AND METHODS: The study group comprised of 32 patients with stable angina pectoris and normal heart function, aged 50.9 ± 4 years; 23 men (71.8%). At baseline we performed echocardiography, cardiopulmonary exercise testing and determined serum levels of B-type natriuretic peptide and C-reactive protein. 24 months later we performed echocardiography and cardiopulmonary exercise testing. RESULTS: Patients with stable angina pectoris and normal LV function are at risk of developing the impairment of LV function. Diastolic dysfunctions of LV are a crucial element of the whole clinical picture. 53.1% developed of LV diastolic dysfunction: 37% isovolumetric relaxation disorders and 15% pseudonormalization. The analysis of the tests carried out after a 2-year observation indicated a relation-ship between developing diastolic dysfunction of LV and the presence of type II diabetes (p = 0.01). Peak oxygen consumption (VO2peak) at baseline was significantly lower in patients who developed diastolic dysfunction of LV a er 2 years (p = 0.03). CONCLUSIONS: The predictors of LV diastolic function deterioration in a 2-year observation in this group of patients include type II diabetes and peak oxygen consumption VO2peak.

[Analysis of lifestyle and risk factors of atherosclerosis in students of selected universities in Krakow].

Introduction: Reduction of risk factors of atherosclerosis, lifestyle modification significantly cause the reduction in the incidence, morbidity and mortality of cardiovascular diseases (CVDs). Objective: To evaluate cardiovascular risk factors and analyze the lifestyle of students finishing the first year of studies at selected universities in Krakow. Material and Methods: The study was performed in 2015roku. 566 students finishing the first year of study, including 319 (56.4%) men and 247 (43.6%) women were examined. The students were in age from 18 to 27 years, an average of 20.11± 1.15 years. They represented 6 different universities in Cracow. In order to assess eating habits, lifestyle and analysis of risk factors of cardiovascular disease was used method of diagnostic survey using the survey technique. BMI was calculated from anthropometric measurements. The program Statistica 12.0 were used in statistical analysis. Results: The analysis showed that most fruits and vegetables consume UR students and AWF, least of AGH. Only 34.8% of students regularly consume fish of the sea, there were no significant differences between universities. Sports frequently cultivate the students of AWF (93% of the students of this university). Academy of Fine Arts students drink the most coffee. Students of AGH frequently consume alcohol. 60% of all students never tried drugs, but only 25.7% of student of Fine Arts never tried drugs. Overweight occurs in 12.6% of students, and obesity in 1.1%. Conclusions: The most risk factors of atherosclerosis occur in students of AGH and ASP. The results of the study clearly indicate on the necessity of implementation of prevention and improvement of health behaviors in students of AGH and ASP universities.

[The prognostic value of cardio-pulmonary exercise test parameters in patients with asymptomatic ischemic heart dysfunction during 2-years observation]. / Prognostycna wartosc parametrów próby spiroergometrycznej u chorych z bezobjawowym uposledzeniem funkcji serca o etiologii niedokrwiennej w czasie dwuletniej obserwacji.

UNLABELLED: Measurement of oxygen uptake at the maximal exercise (VO2max) in the cardio-pulmonary exercise test provides the most reliable information about exertion tolerance. AIM OF THE STUDY: Establishment of VO2peak, VE/CO2 and AT value in the early diagnosis of asymptomatic heart dysfunction in patients with coronary disease (CAD) and prognosis during 2-years observation. The study population: 57 patients (35 M) with CAD, without any signs or symptoms of heart dysfunction, without any features of myocardial infarction, in the age 51.08 +/- 4.01. METHODS: The analysis was performed twice: in the beginning and after 2-years observation. Physical examinations, echocardiographic parameters [(assessment of systolic and diastolic dysfunction of the left ventricle (LV)] and spiroergometric parameters (VO2peak, VE/CO2 at AT). On the basis of echocardiographic examination, there were created groups of patients: Group A--the patients with normal LV function (n=32; 56.2%; 23 M); Group B--the patients with diastolic heart dysfunction (n=22; 38.6%; 10 M); RESULTS: Group A--32 patients in the age of 50.9 +/- 4, 23 men. Values of VO2pe ak :28.8 +/- 6 ml/kg/min, VE/CO2 28.8 +/- 4.9 and AT 18 +/- 2.5. Group B--the patients with diastolic heart dysfunction: 22 (39%) patients; 10 men, in the age of 51.2 +/- 4.3. Values of VO2peak: 26 +/- 3.4 mi/ kg/min, VE/CO2 31.2 +/- 5.1 and AT 16 +/- 2.5. In the beginning of the study was established significantly differences between anaerobic threshold and degree of heart dysfunction (p=0.039). CONCLUSIONS: (1) There was observed that VO2 A and VE/CO2 depended on filling LV profile LV and also of systolic LV function. Anaerobic threshold significantly depended on LV filling pattern. (2) In asymptomatic patients with LV diastolic dysfunction and VO2peak < or = 18.4 ml/kg/min was observed progression of LV diastolic dysfunction during two years.

[Asymptomatic ischemic heart dysfunction, echocardiographic changes and NT-proBNP during 2-years observation]. / Bezobjawowe uposledzenie funkcji serca o etiologii niedokrwiennej z uwzglednieniem zmian echokardiograficznych i stezenia peptydu natriuretycznego NT-proBNP w obserwacji dwuletniej.

BACKGROUND: Asymptomatic systolic dysfunction of the left ventricle (LV) refers to patients without current clinical symptoms of heart failure. AIM: 1. Analysis of echocardiographic parameters in patients with stable angina pectoris without symptoms of heart failure and their changes in two years time 2. Determine the importance of NT-proBNP for early detection of asymptomatic heart dysfunction in patients with stable angina pectoris and its influence on the prognosis in two years 3. Analysis of the relationship between the degree of the left ventricular diastolic dysfunction and co-morbidities and selected echocardiographic parameters 4. Significance of prognostic selected echocardiographic parameters (E/ Vp, E/E', Ar) in patients with stable angina pectoris without any symptoms of heart failure. PATIENTS: The study included 57 patients with stable ischemic heart disease, no history of myocardial infarction: including 35 men (61.4%) aged 35-56 years (mean 51.08 +/- 4.01 years) hospitalized in the Department of Coronary Artery Disease, Institute of Cardiology, Jagiellonian University in Krakow. Analysis after two years involved 56 patients (1 patient died after a year of observation). METHODS: Patients were evaluated 2x: before and after 2 years (assessment of clinical status: physical examination, the severity of angina and physical examination, atherosclerotic risk factors, ECG, lipid profile, plasma NT-proBNP). Patients were divided into three groups: Group A, patients with LV normal function (32 patients), Group B - with impaired diastolic function (22), Group C - with impaired systolic and diastolic function (EF < or = 50%, as measured by Simpson; 3 patients). RESULTS: Subgroups of respondents ABC did not differ significantly with respect to age, sex and risk fac- tors of atherosclerosis. There was a significant correlation between the type of LV dysfunction and indicators of elevated end diastolic pressure in LV: E/Vp (p = 0.0002), E/E' (p = 0.0006), Ar (p = 0.034) and the propagation velocity Vp (0 = 0.001). There was a significant correlation between systolic and diastolic heart dysfunction and the levels of NT-proBNP (p = 0.018). After 2 years, patients with deterioration of heart function in group A noticed a significant correlation between occurrence of diastolic dysfunction and presence of diabetes mellitus type II (p = 0.01). Conclusions: 1. Elevated levels of NT-proBNP indicates the impairment of systolic andlor diastolic asymptomatic patients. NT-proBNP is therefore important for early detection of asymptomatic cardiac dysfunction in patients with stable angina pectoris. 2. In patients with stable angina pectoris without symptoms of heart failure: the value of E/Vp > or = 1.5 and E/E '> or = 8 can be the marker of more advanced coronary atherosclerosis, manifested by three-vessel disease or stenosis of the left main coronary artery.

[Blood serum osteocalcin and beta-crosslaps concentrations in patients after renal transplantation]. / Stezenie osteokalcyny i beta-crosslaps w surowicy krwi u pacjentów po zabiegu przeszczepienia nerki--obserwacja wstepna.

In 16 patients (7 males, 9 females), aged 47.2 +/- 15.9 years, blood serum concentrations of osteocalcin, beta-crosslaps, parathormone, calcium, phosphate, creatinine and urea were determined before renal transplantation and 3 and 6 months following the procedure. Three as well as six months following renal transplantation significant decrease in blood serum concentration of osteocalcin and beta-crosslaps are found. A significant positive correlation between osteocalcin and beta-crosslaps concentration was found in each investigated period. Six-months observation revealed only partial correction of bone metabolism following renal transplantation.

How does preclinical laboratory training impact physical examination skills during the first clinical year? A retrospective analysis of routinely collected objective structured clinical examination scores among the first two matriculating classes of a reformed curriculum in one Polish medical school.

OBJECTIVE: As a result of a curriculum reform launched in 2012 at our institution, preclinical training was shortened to 2 years instead of the traditional 3 years, creating additional incentives to optimise teaching methods. In accordance with the new curriculum, a semester-long preclinical module of clinical skills (CS) laboratory training takes place in the second year of study, while an introductory clinical course (ie, brief introductory clerkships) is scheduled for the Fall semester of the third year. Objective structured clinical examinations (OSCEs) are carried out at the conclusion of both the preclinical module and the introductory clinical course. Our aim was to compare the scores at physical examination stations between the first and second matriculating classes of a newly reformed curriculum on preclinical second-year OSCEs and early clinical third-year OSCEs. DESIGN: Analysis of routinely collected data. SETTING: One Polish medical school. PARTICIPANTS: Complete OSCE records for 462 second-year students and 445 third-year students. OUTCOME MEASURES: OSCE scores by matriculation year. RESULTS: In comparison to the first class of the newly reformed curriculum, significantly higher (ie, better) OSCE scores were observed for those students who matriculated in 2013, a year after implementing the reformed curriculum. This finding was consistent for both second-year and third-year cohorts. Additionally, the magnitude of the improvement in median third-year OSCE scores was proportional to the corresponding advancement in preceding second-year preclinical OSCE scores for each of two different sets of physical examination tasks. In contrast, no significant difference was noted between the academic years in the ability to interpret laboratory data or ECG - tasks which had not been included in the second-year preclinical training. CONCLUSION: Our results suggest the importance of preclinical training in a CS laboratory to improve students' competence in physical examination at the completion of introductory clinical clerkships during the first clinical year.

[The modern view on the role of inflammatory factors in chronic heart failure and possibilities of pharmacological modification]. / Wspólczesne poglady na temat roli czynników zapalnych w niewydolnosci serca i mozliwosci ich farmakologicznej modyfikacji.

Chronic heart failure (CHF) is the state of reciprocal influences of neurohormonal factors and inflammatory markers. Many years of research and observations proved a particular meaning of cytokines and acute phase proteins in the pathophysiology of CHF. These markers are responsible for the repairing processes. There is a correlation between the activity of inflammatory factors, their plasma concentrations and clinical state of the patient. Basing on the cytokine's concentrations, the level of C-Reactive Protein (CRP) in the patient's blood and their changes in time we can predict the progression of the disease. Known medical references emphasise the fact that the pharmacological modification of inflammatory markers (interleukins, TNF-alfa, CRP) can have significant clinical consequences and in some cases can even cause regression of pathological symptoms. CRP plays an important role in the development and progression CHF and can be the clinical predictor not only in the cases of coronary disease but also can be useful in the group of patients with CHF. The introduction of drugs influencing CRP, interleukins and TNF-alfa levels to CHF therapy can be an effective solution called 'a golden therapy' improving clinical state and quality of patient's life.

[Diastolic dysfunction as a risk factor in patients with heart failure]. / Rozkurczowa niewydolnosc serca jako czynnik ryzyka u pacjentów z niewydolnoscia krazenia.

In the recent decade diastolic dysfunction has been extensively studied. It has been found that the clinical syndrome of heart failure may result from two entirely different disorders--systolic and diastolic impairment or both. Available evidence indicates that the left ventricular filling pattern is altered with progressing diastolic dysfunction. Left ventricular diastolic dysfunction is a sensitive marker of myocardial damage and it can be used to monitor a spectrum of changes ranging from impaired relaxation through pseudo-normalization to restrictive filling pattern. The restrictive filling pattern, irrespective of its etiology, has a negative effect on prognosis, especially when it coincides with reduced left ventricular ejection fraction. Patients with systolic heart failure and restrictive filling pattern show a lower exercise tolerance than their counterparts with non-restrictive filling. This indicates a significant role of diastolic dysfunction in the development of clinical symptoms in patients with left ventricular systolic impairment. Progress in the understanding of diastolic dysfunction may allow for better evaluation of prognosis and therapeutic efficacy and for monitoring of patients with systolic dysfunction.