Heart failure with a normal ejection fraction: is measurement of diastolic function necessary to make the diagnosis
M R Zile1, W H Gaasch, J D Carroll
1Medical University of South Carolina, Charleston, USA.
Circulation
|August 15, 2001
Summary
Diastolic heart failure diagnosis in patients with normal ejection fraction is confirmed by objective measurements of left ventricular (LV) diastolic function, which were abnormal in all patients studied.
Area of Science:
- Cardiology
- Cardiovascular Physiology
Background:
- Diastolic heart failure diagnosis often relies on clinical presentation in patients with preserved left ventricular ejection fraction.
- The necessity of objective diastolic function measurements for diagnosis remains debated.
Purpose of the Study:
- To investigate the prevalence of abnormal left ventricular (LV) diastolic function in patients presenting with heart failure and a normal ejection fraction.
Main Methods:
- Prospective study of 63 patients with heart failure and normal ejection fraction, assessed via echocardiography and cardiac catheterization.
- Hemodynamic measurements and detailed micromanometer and echocardiographic-Doppler studies were performed.
- Evaluated parameters included LV end-diastolic pressure, LV relaxation time constant, E/A ratio, and E-wave deceleration time.
Main Results:
- 92% of patients exhibited elevated LV end-diastolic pressure.
- 79% showed an abnormal time constant of LV relaxation.
- Abnormalities in diastolic function indexes were present in all patients, with 48% having an abnormal E/A ratio and 64% an abnormal E-wave deceleration time.
Conclusions:
- Objective measurement of LV diastolic function confirms the diagnosis of diastolic heart failure.
- The diagnosis can be established clinically even without objective diastolic function parameter measurements.
Related Concept Videos
01:17Pathophysiology of Heart Failure
4.8K
Heart failure (HF) is a progressive syndrome involving ventricles that leads to inadequate cardiac output. It can be classified based on location and output or ejection fraction. Ejection fraction (EF) is an essential measurement in the diagnosis and surveillance of HF. Reduced EF corresponds to systolic heart failure (HFrEF). However, HF with preserved ejection fraction (HFpEF) is becoming increasingly prevalent. Also known as diastolic HF, this form of HF is related to aging. The...
4.8K
01:22Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies
1.3K
The key clinical manifestations of Rheumatic heart disease (RHD) include several distinct cardiac symptoms.Carditis, a hallmark of acute rheumatic fever, involves inflammation of the heart's endocardium, myocardium, and pericardium. Chronic RHD often results from recurrent episodes of carditis. Its symptoms include the following:Murmurs are caused by valvular damage, especially to the mitral and aortic valves. Mitral stenosis or regurgitation is common, with characteristic heart murmurs...
1.3K
01:27Heart Failure I: Introduction
1.7K
Heart failure refers to a clinical syndrome caused by structural or functional cardiac disorders that prevent the heart from pumping an adequate amount of blood to meet the body's metabolic needs. This condition often arises from myocardial infarction or ischemia, leading to decreased cardiac output, reduced tissue perfusion, impaired gas exchange, fluid volume imbalance, and decreased functional ability.Heart failure can result from disruptions in the mechanisms that regulate cardiac output...
1.7K
01:29Heart Failure II: Pathophysiology
1.9K
Systolic Heart Failure and Compensatory MechanismsSystolic heart failure (also termed HFrEF, Heart Failure with Reduced Ejection Fraction) is the most prevalent type of heart filure. It results in a decreased volume of blood being pumped from the ventricle. The aortic arch and carotid sinuses have baroreceptors that detect reduced blood pressure, triggering the sympathetic nervous system (SNS) to release epinephrine and norepinephrine. Initially, this response aims to boost heart rate and...
1.9K
01:30Heart Failure IV: Classification and Diagnostic Evaluation
1.0K
Heart failure can be classified in various ways, with the most common classifications based on physical activity limitations, disease progression, severity, and treatment strategies.The Functional Classification of Heart Failure divides patients into four categories based on physical activity limitation due to symptom burden.Class I: Patients in this class have cardiac disease but no physical activity limitations. Ordinary activities like walking, climbing stairs, or routine tasks do not cause...
1.0K
01:30Cardiomyopathy II: Dilated Cardiomyopathy
790
Dilated cardiomyopathy, or DCM, is a progressive myocardial disorder characterized by ventricular chamber dilation and contractile dysfunction.EtiologyVarious factors can cause DCM, including hypertension and heavy alcohol intake, which contribute to the weakening and enlargement of the heart muscle. Viral infections, such as Coxsackievirus B, adenoviruses, and influenza, can lead to DCM by causing inflammation and damage to heart tissue. Certain chemotherapeutic agents, including daunorubicin,...
790