Heart failure with normal ejection fraction

Czech version

Authors: J. Hradec
Authors‘ workplace: III. interní klinika 1. LF UK a VFN
Published in: Kardiol Rev Int Med 2008, 10(3): 111-116

Overview

Heart failure with normal ejection fraction (EF) reffered to also as heart failure with preserved systolic function or diastolic heart failure, accounts for more than 50 % of all heart failure cases. Its diagnosis requires the following conditions to be satisfied: (1) symptoms and signs of heart failure, (2) normal systolic function (EF) of the left ventricle, (3) evidence of diastolic dysfunction. As a normal systolic function is supposed EF > 0,50. Diagnostic evidence of diastolic dysfunction can be obtained invasively (e.g. left ventricular filling pressure > 16 mm Hg or pulmonary wedge pressure 12 mm Hg) or non-invasively by tissue Doppler (TDI). A reliable equivalent of diastolic dysfunction is left ventricular hypertrophy. Supportive non-invasive evidence of diastolic dysfunction bring Doppler transmitral flow curve or pulmonary veins blood flow, left atrial volume index and presence of atrial fibrillation. Estimation of plasma levels of natriuretic peptides makes the diagnosis of heart failure more precise. Their normal levels have high negative predictive value.

A number of large randomized, placebo-controlled clinical trials provided evidence-based data to guide the treatment of patients with systolic heart failure. For heart failure with normal EF, with one exception (CHARM trial), such studies are missing or not yet completed. Therefore, the treatment of patients with heart failure with normal EF remains empirical.

Key words:
heart failure with normal ejection fraction – left ventricular diastolic dysfunction – tissue Doppler – natriuretic peptides

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Article was published in

Cardiology Review

2008 Issue 3