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Contribution of left ventricular diastolic dysfunction to heart failure regardless of ejection fraction
Steffen Brucks1, William C Little, Tania Chao
1Cardiology Section, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
Insights
Diastolic dysfunction is prevalent in heart failure (HF) irrespective of ejection fraction. This dysfunction, not ejection fraction, predicts B-type natriuretic peptide levels and mortality in HF patients.
Area of Science:
- Cardiology
- Cardiovascular Physiology
Background:
- Heart failure (HF) is traditionally classified by left ventricular ejection fraction (LVEF).
- The role of diastolic dysfunction in HF, independent of LVEF, requires further investigation.
Purpose of the Study:
- To investigate the prevalence and impact of left ventricular diastolic dysfunction in patients with clinical heart failure.
- To determine if diastolic dysfunction is a better predictor of clinical outcomes and biomarkers than LVEF.
Main Methods:
- Assessed diastolic dysfunction using mitral filling patterns and tissue Doppler imaging in 206 HF patients and 72 controls.
- Correlated diastolic dysfunction with B-type natriuretic peptide levels, LVEF, and end-diastolic volume index (EDVI).
- Analyzed the impact of diastolic dysfunction and LVEF on survival rates.
Main Results:
- Diastolic dysfunction was present in over 90% of HF patients, regardless of LVEF, and was more severe than in controls.
- Diastolic dysfunction correlated with B-type natriuretic peptide levels and predicted survival, unlike LVEF or EDVI.
- HF patients with preserved LVEF (>0.50) showed mild systolic dysfunction and increased ventricular mass/EDVI ratio; those with reduced LVEF (<=0.40) exhibited systolic dysfunction and ventricular dilation.
Conclusions:
- Left ventricular diastolic dysfunction is a key feature of heart failure across all ejection fraction ranges.
- Diastolic dysfunction is a more significant predictor of B-type natriuretic peptide levels and mortality than LVEF or EDVI.
- HF with preserved ejection fraction involves diastolic and mild systolic dysfunction, while HF with reduced ejection fraction involves diastolic, systolic dysfunction, and dilation.
Abstract:
Heart failure (HF) has been classified as systolic and diastolic based on the left ventricular ejection fraction. We hypothesized that left ventricular diastolic dysfunction is an important element of HF regardless of ejection fraction. Two hundred six patients who had clinical HF were compared with 72 age-matched controls. Diastolic dysfunction, as assessed by the mitral filling pattern and tissue Doppler imaging, was present in >90% of patients who had HF regardless of ejection fraction and was more frequent and severe than in age-matched controls (p <0.001). In patients who had HF, B-type natriuretic peptide correlated with diastolic dysfunction (r = 0.62, p <0.001) but not with ejection fraction or end-diastolic volume index (EDVI). The degree of diastolic dysfunction influenced survival rate (risk ratio 1.64, p <0.05), whereas ejection fraction and EDVI did not. Systolic function measured by systolic mitral annular velocity was decreased in patients who had HF and an ejection fraction /=0.50 (6.6 +/- 1.8 cm/s) compared with control subjects (8.0 +/- 2.1 cm/s, p <0.01). Patients who had HF and an ejection fraction >/=0.50 had an increased ratio of ventricular mass to EDVI. Patients who had HF and an ejection fraction /=0.50 is associated with mild systolic dysfunction and an increased ratio of left ventricular mass to EDVI. In HF with an ejection fraction
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