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Doppler-echocardiographic indices of diastolic function in heart failure admissions with preserved left ventricular
John M Cahill1, Mairead Horan, Peter Quigley
1Cardiomyopathy Research Centre, St. Vincent's University Hospital, University College Dublin, Ireland.
Insights
Many heart failure hospital admissions involve preserved systolic function. However, only 43% of these patients met diastolic heart failure criteria, leaving the cause for the rest unclear.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Heart Failure Research
Background:
- Heart failure with preserved ejection fraction (HFpEF) is common in hospital admissions.
- The precise incidence and diagnostic criteria for diastolic dysfunction in these cases are not well-established.
Purpose of the Study:
- To investigate the prevalence and diagnostic confirmation of diastolic dysfunction in patients admitted with heart failure and preserved left ventricular systolic function.
- To utilize European Study Group on Diastolic Heart Failure (ESGDHF) Doppler-echocardiographic criteria.
Main Methods:
- Studied 309 sequential admissions for suspected heart failure, confirming primary heart failure in 210.
- Assessed left ventricular ejection fraction, wall thickness, and diastolic parameters (E:A ratio, E-wave deceleration time, isovolumic relaxation time) via Doppler echocardiography.
- Focused on 56 patients with preserved ejection fraction (>45%) and no significant valvular disease.
Main Results:
- Of 56 patients with preserved systolic function, only 43% met the ESGDHF criteria for diastolic heart failure.
- Elevated E-wave deceleration time (>280 ms) was observed in 42%, reversed E:A ratio in 30/36 (sinus rhythm), and prolonged isovolumic relaxation time (>105 ms) in 38%.
- Increased wall thickness was present in 75% of these patients.
Conclusions:
- In clinically confirmed heart failure admissions with preserved systolic function, a significant proportion (57%) did not meet established criteria for diastolic heart failure.
- The underlying pathophysiology for heart failure in these patients remains unclear and warrants further investigation.
Abstract:
Many patients admitted to hospital with heart failure have preserved left ventricular (LV) systolic function. The incidence of isolated diastolic dysfunction as a cause of such admission remains unclear. We aimed to examine diastolic function in unselected admissions from the community with heart failure using the European Study Group on Diastolic Heart Failure (ESGDHF) Doppler-echocardiographic indices of diastolic dysfunction. Primary heart failure was confirmed in 210 of 309 sequential admissions with suspected heart failure. Doppler echocardiography was used to assess left ventricular ejection fraction, wall thickness and parameters of diastolic function including E:A ratio, E-wave deceleration time and isovolumic relaxation time. Of 210 patients studied (118 female), ejection fraction was <45% in 111, leaving a population of 99 with preserved systolic function. We excluded those with significant valvular disease, leaving 56 patients (mean age=77 years) with an ejection fraction >45% and no other relevant abnormality. Twenty were in atrial fibrillation. E-wave deceleration time was >280 ms in 42%. E:A was reversed in 30 of 36 patients in sinus rhythm, but only seven met the ESGDHF criterion of E:A<0.5. Isovolumic relaxation time was >105 ms in 38%. Wall thickness was increased in 75% of cases. The ESGDHF Doppler-echocardiographic criteria for diastolic heart failure were fulfilled in 43%. In clinically confirmed heart failure, 27% of patients had preserved systolic function and no significant valvular disease. Only 43% of this group had confirmed diastolic heart failure by these ESGDHF criteria. The pathophysiological basis of the syndrome in the remaining 57% remains unclear.