Systolic dysfunction in heart failure with a normal ejection fraction: echo-Doppler measurements

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.