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Congestive heart failure with normal ejection fraction. A different mechanism requiring different therapy
W B Rogers1, L M Prisant, J L Houghton
1Section of Cardiology, Medical College of Georgia, Augusta 30912-3105.
Insights
Diastolic dysfunction can mimic congestive heart failure with normal systolic function. Accurate diagnosis via noninvasive testing is crucial, as standard treatments for systolic dysfunction may be harmful.
Area of Science:
- Cardiology
- Heart Failure Research
Background:
- Congestive heart failure (CHF) can present with normal left ventricular systolic function.
- Standard therapies for systolic dysfunction may be ineffective or harmful in these cases.
Purpose of the Study:
- To highlight the importance of recognizing diastolic dysfunction in patients with suspected CHF and normal systolic function.
- To discuss the role and limitations of noninvasive testing in diagnosing diastolic dysfunction.
Main Methods:
- Review of clinical presentation suggestive of CHF.
- Evaluation of chest radiography findings.
- Assessment of left ventricular systolic function.
- Consideration of noninvasive testing for diastolic function.
Main Results:
- Diastolic dysfunction is a common cause of CHF with preserved ejection fraction.
- Noninvasive testing can aid diagnosis but has limitations.
- Abnormal diastolic indexes alone, without clinical signs, do not confirm diastolic dysfunction.
Conclusions:
- Clinicians should consider diastolic dysfunction in CHF presentations with normal systolic function.
- Careful interpretation of noninvasive testing is essential.
- Treatment should be guided by clinical presentation and confirmed diagnosis, not solely by abnormal diastolic indexes.
Abstract:
Clinicians must remain undaunted when history, physical examination, and chest radiography suggest congestive heart failure but left ventricular systolic function is normal. Many of these patients have diastolic dysfunction, and standard therapy for left ventricular systolic dysfunction is often ineffectual or detrimental. Noninvasive testing is subject to many pitfalls but may confirm a clinical suspicion and provide indications to treat or to proceed with invasive testing. In the absence of clinical signs and symptoms of congestive failure, however, abnormal diastolic indexes should not be interpreted as diagnostic of diastolic dysfunction and are not an indication to treat.