How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology

University of Oslo, Kristiania (historical), Oslo, Norway
European Heart Journal (Impact Factor: 14.72). 10/2007; 28(20):2539-50. DOI: 10.1093/eurheartj/ehm037
Source: PubMed

ABSTRACT Diastolic heart failure (DHF) currently accounts for more than 50% of all heart failure patients. DHF is also referred to as heart failure with normal left ventricular (LV) ejection fraction (HFNEF) to indicate that HFNEF could be a precursor of heart failure with reduced LVEF. Because of improved cardiac imaging and because of widespread clinical use of plasma levels of natriuretic peptides, diagnostic criteria for HFNEF needed to be updated. The diagnosis of HFNEF requires the following conditions to be satisfied: (i) signs or symptoms of heart failure; (ii) normal or mildly abnormal systolic LV function; (iii) evidence of diastolic LV dysfunction. Normal or mildly abnormal systolic LV function implies both an LVEF > 50% and an LV end-diastolic volume index (LVEDVI) <97 mL/m(2). Diagnostic evidence of diastolic LV dysfunction can be obtained invasively (LV end-diastolic pressure >16 mmHg or mean pulmonary capillary wedge pressure >12 mmHg) or non-invasively by tissue Doppler (TD) (E/E' > 15). If TD yields an E/E' ratio suggestive of diastolic LV dysfunction (15 > E/E' > 8), additional non-invasive investigations are required for diagnostic evidence of diastolic LV dysfunction. These can consist of blood flow Doppler of mitral valve or pulmonary veins, echo measures of LV mass index or left atrial volume index, electrocardiographic evidence of atrial fibrillation, or plasma levels of natriuretic peptides. If plasma levels of natriuretic peptides are elevated, diagnostic evidence of diastolic LV dysfunction also requires additional non-invasive investigations such as TD, blood flow Doppler of mitral valve or pulmonary veins, echo measures of LV mass index or left atrial volume index, or electrocardiographic evidence of atrial fibrillation. A similar strategy with focus on a high negative predictive value of successive investigations is proposed for the exclusion of HFNEF in patients with breathlessness and no signs of congestion. The updated strategies for the diagnosis and exclusion of HFNEF are useful not only for individual patient management but also for patient recruitment in future clinical trials exploring therapies for HFNEF.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Coronary artery calcification (CAC) is associated with the incidence of congestive heart failure. We evaluated the association between CAC and left ventricular diastolic dysfunction (LVDD) in elderly patients without coronary artery disease. Coronary computed tomography was performed in 1,021 consecutive patients >55 years of age who were suspected of having coronary artery disease. A total of 530 patients (age, 70 ± 8 years; 56 % men) with a LV ejection fraction >50 % and without obstructive coronary artery disease and a history of coronary artery disease were included in the analysis. LVDD was defined according to a standard algorithm by echocardiography (septal e' <8, lateral e' <10, and left atrial volume index ≥34 mL/m(2)). A total of 224 of 530 patients had LVDD. CAC scores in patients with LVDD were higher than those in patients without LVDD (p < 0.01). The prevalence of LVDD in patients with CAC scores ≥400 was greater than that in patients with CAC scores of 0-9 (58 vs. 34 %, p < 0.01). After adjustment for confounding factors, the CAC score was associated with LVDD, with an odds ratio of 1.96 (95 % confidence interval: 1.11-3.43, p = 0.02) for a CAC score ≥400 compared with a CAC score of 0-9. A CAC score ≥400 was associated with LVDD in elderly patients without CAD in this population. Further prospective studies are needed to evaluate the clinical relevance of CAC as a risk of heart failure with preserved ejection fraction.
    Heart and Vessels 02/2015; DOI:10.1007/s00380-015-0645-5 · 2.11 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Diastolic heart failure (HF), the prevalence of which is gradually increasing, is associated with cardiovascular (CV) morbidity and mortality in the general population and, more specifically, in patients with end-stage renal disease (ESRD). However, the impact of diastolic dysfunction on CV outcomes has not been studied in incident dialysis patients with preserved systolic function. This prospective observational cohort study investigates the clinical consequence of diastolic dysfunction and the predictive power of diastolic echocardiographic parameters for CV events in 194 incident ESRD patients with normal or near normal systolic function, who started dialysis between July 2008 and August 2012. During a mean follow-up duration of 27.2 months, 57 patients (29.4%) experienced CV events. Compared to the CV event-free group, patients with CV events had a significantly higher left ventricular (LV) mass index, ratio of early mitral flow velocity (E) to early mitral annulus velocity (E') (E/E'), LA volume index (LAVI), deceleration time, and right ventricular systolic pressure, and a significantly lower LV ejection fraction and E'. In multivariate Cox proportional hazard analysis, E/E'>15 and LAVI>32 mL/m2 significantly predicted CV events (E/E'>15: hazard ratio [HR] = 5.40, 95% confidence interval [CI] = 2.73-10.70, P< .001; LAVI>32 mL/m2: HR = 5.56, 95% CI = 2.28-13.59, P< .001]. Kaplan-Meier analysis revealed that patients with both E/E'>15 and LAVI>32mL/m2 had the worst CV outcomes. An increase in E/E' or LAVI is a significant risk factor for CV events in incident dialysis patients with preserved LV systolic function.
    PLoS ONE 03/2015; 10(3):e0118694. DOI:10.1371/journal.pone.0118694 · 3.53 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Heart failure with preserved left ventricular ejection fraction (HFPEF) affects about half of all patients diagnosed with heart failure. The pathophysiological aspect of this complex disease state has been extensively explored, yet it is still not fully understood. Since the sympathetic nervous system is related to the development of systolic HF, we hypothesized that an increased sympathetic nerve activation (SNA) is also related to the development of HFPEF. This review summarizes the available literature regarding the relation between HFPEF and SNA. Electronic databases and reference lists through April 2014 were searched resulting in 7722 unique articles. Three authors independently evaluated citation titles and abstracts, resulting in 77 articles reporting about the role of the sympathetic nervous system and HFPEF. Of these 77 articles, 15 were included for critical appraisal: 6 animal and 9 human studies. Based on the critical appraisal, we selected 9 articles (3 animal, 6 human) for further analysis. In all the animal studies, isoproterenol was administered to mimic an increased sympathetic activity. In human studies, different modalities for assessment of sympathetic activity were used. The studies selected for further evaluation reported a clear relation between HFPEF and SNA. Current literature confirms a relation between increased SNA and HFPEF. However, current literature is not able to distinguish whether enhanced SNA results in HFPEF, or HFPEF results in enhanced SNA. The most likely setting is a vicious circle in which HFPEF and SNA sustain each other.
    PLoS ONE 02/2015; 10(2):e0117332. DOI:10.1371/journal.pone.0117332 · 3.53 Impact Factor


Available from
Jun 3, 2014

Similar Publications