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Systolic dysfunction in heart failure with a normal ejection fraction: echo-Doppler measurements
John E Sanderson1, Alan G Fraser
1Keele University Medical School, Stoke-on-Trent, UK. john.sanderson@uhns.nhs.uk
Progress in Cardiovascular Diseases
|November 7, 2006
Summary
Heart failure with preserved ejection fraction (HFpEF) involves more than just diastolic dysfunction; systolic abnormalities also exist. Ejection fraction alone is an unreliable measure for classifying heart failure patients.
Area of Science:
- Cardiology
- Cardiovascular Physiology
Background:
- Heart failure with preserved ejection fraction (HFpEF), or diastolic heart failure, is traditionally viewed as having normal systolic function.
- However, emerging evidence suggests systolic dysfunction is present in HFpEF, particularly in longitudinal function.
Purpose of the Study:
- To re-evaluate the characterization of systolic and diastolic function in heart failure.
- To assess the utility of ejection fraction as a sole diagnostic criterion for heart failure.
Main Methods:
- Utilized advanced Doppler-echocardiographic techniques.
- Analyzed ventricular function, including longitudinal and radial mechanics.
- Correlated findings with aging and common HFpEF precursors like hypertension, diabetes, and ischemia.
Main Results:
- Ventricular systolic function is abnormal in HFpEF, especially along the long axis.
- Preserved ejection fraction is maintained by compensatory increases in radial function.
- A spectrum of systolic dysfunction exists, with HFpEF in an intermediate position.
Conclusions:
- Ejection fraction is an inadequate and arbitrary measure for dichotomizing heart failure patients.
- HFpEF patients exhibit a combination of systolic and diastolic abnormalities.
- Individualized assessment of cardiac remodeling and function is crucial for accurate diagnosis and management.
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