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Congestive heart failure from left ventricular diastolic dysfunction in systemic hypertension

M Iriarte1, N Murga, D Sagastagoitia

  • 1University of the Basque Country, Institute of Cardiology, Hospital Civil de Basurto, Bilbao (Bizkaia), Spain.

The American Journal of Cardiology
|February 1, 1993
PubMed

Insights

Congestive heart failure with normal ejection fraction in hypertensive patients presents two distinct profiles: one with severe hypertrophy and another with significant myocardial ischemia. Treatment should target the specific underlying cause for better outcomes.

Area of Science:

  • Cardiology
  • Internal Medicine
  • Hypertension Research

Background:

  • Congestive heart failure (CHF) with preserved ejection fraction (HFpEF) was previously considered clinically uniform.
  • Distinguishing HFpEF profiles is crucial for targeted therapeutic strategies.

Purpose of the Study:

  • To investigate distinct clinical and pathophysiological profiles within hypertensive patients experiencing CHF with normal ejection fraction.
  • To identify subgroups within HFpEF based on echocardiographic hypertrophy and myocardial ischemia.

Main Methods:

  • Studied 36 hypertensive patients with recent CHF and normal ejection fraction (> or = 50%).
  • Divided patients into two groups based on ventricular mass/volume ratio (Group A: >1.8, Group B: <1.8).
  • Utilized echocardiography, thallium-201 scintigraphy, and clinical assessments (auscultation, cardiothoracic ratio).

Main Results:

  • Group A (high hypertrophy) showed higher ejection fraction, smaller ventricular diameters, and lower thallium-201 positivity (indicating less ischemia).
  • Group B (less hypertrophy) had a higher rate of myocardial ischemia, evidenced by thallium-201 uptake and coronary stenosis.
  • Clinical findings differentiated groups: Group A had more S4 sounds and smaller cardiothoracic ratios; Group B had more S3 sounds.

Conclusions:

  • Hypertensive CHF with normal ejection fraction manifests as two distinct phenotypes: one dominated by severe left ventricular hypertrophy and the other by significant myocardial ischemia.
  • Therapeutic approaches should be tailored: regression of hypertrophy for the first profile and improvement of ischemia for the second.

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