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Approach to patients with heart failure and normal ejection fraction
1Department of Internal Medicine, Mayo Clinic, Rochester, Minn 55905, USA.
Insights
Diastolic heart failure (HF) affects half of patients diagnosed with HF and presents similarly to systolic HF. Understanding risk factors and echocardiographic findings aids in confident diagnosis and management.
Area of Science:
- Cardiology
- Internal Medicine
- Echocardiography
Background:
- Heart failure (HF) with preserved ejection fraction (diastolic HF) accounts for approximately 50% of HF diagnoses.
- Diastolic HF often presents with clinical and radiographic findings indistinguishable from systolic HF.
- Underlying diastolic dysfunction is the primary cause of congestion in these patients.
Purpose of the Study:
- To review the risk factors, clinical profiles, and echocardiographic findings associated with diastolic HF.
- To enhance clinician confidence in diagnosing diastolic HF.
- To discuss the prognostic implications and therapeutic strategies for diastolic HF.
Main Methods:
- Review of clinical profiles and diagnostic criteria for diastolic HF.
- Analysis of common echocardiographic findings in patients with diastolic dysfunction.
- Synthesis of current literature on prognosis and treatment of diastolic HF.
Main Results:
- Diastolic HF is clinically similar to systolic HF but stems from impaired ventricular relaxation and filling.
- Specific patient profiles and echocardiographic patterns are indicative of diastolic dysfunction.
- Accurate diagnosis is crucial for appropriate management and improved patient outcomes.
Conclusions:
- Identifying patients at risk for diastolic HF is essential for timely diagnosis.
- Echocardiography plays a critical role in confirming diastolic dysfunction.
- Understanding the nuances of diastolic HF improves therapeutic approaches and patient prognosis.
Abstract:
Approximately 50% of patients with a firm clinical diagnosis of heart failure (HF) have a normal ejection fraction. Some patients have valvular disease, but most have underlying diastolic dysfunction that leads to pulmonary and systemic congestion and signs and symptoms of HF. Although diastolic HF is clinically and radiographically indistinguishable from HF with depressed left systolic ventricular function, knowledge of which patients are at risk of diastolic HF, the common clinical profiles, and the common echocardiographic findings enhances the clinician's ability to diagnose diastolic HF with confidence. The prognostic implications of a diagnosis of diastolic HF and the therapeutic approach to such patients are reviewed.