Diagnosis and assessment in heart failure

Heart failure is a common and growing problem. Its optimal and effective management and the evaluation of new therapies require assessment of underlying etiology, type of cardiac dysfunction, severity, prognosis, and response to therapy. Unfortunately, the lack of a universally agreed definition of heart failure and uniform criteria make an accurate and complete diagnosis of heart failure difficult. Currently, a wide range of investigations and assessments is available, including assessment of symptoms, exercise performance, and cardiac function. In particular, left ventricular (LV) ejection fraction (EF) is widely used and a good marker of the severity of LV dysfunction and prognosis. It is now being recognized that the early identification and treatment of patients with asymptomatic LV dysfunction may prevent subsequent progression to symptomatic heart failure. Recently, attention has focused on the neurohormonal activation that occurs early in heart failure, and especially increasing evidence suggests that plasma levels of neurohormones and brain natriuretic peptides, may be useful biochemical markers in the diagnosis and assessment of heart failure at an early stage. Further evaluation of this neurohormonal activation and treatments directed towards it may provide considerable benefits in improving patient morbidity and mortality. (c)1999 by CHF, Inc.