Circulation. 2001;104:779-782
doi: 10.1161/hc3201.094226
doi: 10.1161/hc3201.094226
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(Circulation. 2001;104:779.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Heart Failure With a Normal Ejection Fraction
Is Measurement of Diastolic Function Necessary to Make the Diagnosis of Diastolic Heart Failure?
From the Medical University of South Carolina, Charleston (M.R.Z.); Lahey Clinic, Burlington, Mass (W.H.G.); University of Colorado Health Sciences Center, Denver (J.D.C.); University of Texas Health Science Center, San Antonio (M.D.F.); University of Massachusetts Medical Center, Worcester (G.P.A.); Rush University, Chicago, Ill (G.L.S., P.R.L.); and the Cardiac Centers of Louisiana, Shreveport (J.K.G.).
Reprint requests to William H. Gaasch, MD, Cardiovascular Medicine, Lahey Clinic, 41 Mall Rd, Burlington, MA 01805. E-mail William.H.Gaasch{at}Lahey.Org
Background— The diagnosis of diastolic heart failure is generally made in patients who have the signs and symptoms of heart failure and a normal left ventricular (LV) ejection fraction. Whether the diagnosis also requires an objective measurement of parameters that reflect the diastolic properties of the ventricle has not been established.
Methods and Results— We hypothesized that the vast majority of patients with heart failure and a normal ejection fraction exhibit abnormal LV diastolic function. We tested this hypothesis by prospectively identifying 63 patients with a history of heart failure and an echocardiogram suggesting LV hypertrophy and a normal ejection fraction; we then assessed LV diastolic function during cardiac catheterization. All 63 patients had standard hemodynamic measurements; 47 underwent detailed micromanometer and echocardiographic-Doppler studies. The LV end-diastolic pressure was >16 mm Hg in 58 of the 63 patients; thus, 92% had elevated end-diastolic pressure (average, 24±8 mm Hg). The time constant of LV relaxation (average, 51±15 ms) was abnormal in 79% of the patients. The E/A ratio was abnormal in 48% of the patients. The E-wave deceleration time (average, 349±140 ms) was abnormal in 64% of the patients. One or more of the indexes of diastolic function were abnormal in every patient.
Conclusions— Objective measurement of LV diastolic function serves to confirm rather than establish the diagnosis of diastolic heart failure. The diagnosis of diastolic heart failure can be made without the measurement of parameters that reflect LV diastolic function.
Key Words: heart failure • diastole • hemodynamics • hypertrophy
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|
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|
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|
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|
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|
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|
|
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|
|
|
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|
|
|
|
|
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|
|
|
|
|
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|
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|
|
|
|
|
|
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|
|
|
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|
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|
|
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|
|
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|
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|
|
|
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|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
|
|
P. M Mottram and T. H Marwick Assessment of diastolic function: what the general cardiologist needs to know Heart, May 1, 2005; 91(5): 681 - 695. [Full Text] [PDF]
|
|
|
|
|
|
A Varela-Roman, L Grigorian, E Barge, P Bassante, M G de la Pena, and J R Gonzalez-Juanatey Heart failure in patients with preserved and deteriorated left ventricular ejection fraction Heart, April 1, 2005; 91(4): 489 - 494. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. K. Munagala, C. Y.T. Hart, J. C. Burnett Jr, D. M. Meyer, and M. M. Redfield Ventricular Structure and Function in Aged Dogs With Renal Hypertension: A Model of Experimental Diastolic Heart Failure Circulation, March 8, 2005; 111(9): 1128 - 1135. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Bendjelid, N. Schutz, P. M. Suter, G. Fournier, D. Jacques, S. Fareh, and J.-A Romand Does Continuous Positive Airway Pressure by Face Mask Improve Patients With Acute Cardiogenic Pulmonary Edema Due to Left Ventricular Diastolic Dysfunction? Chest, March 1, 2005; 127(3): 1053 - 1058. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 O. W. Nielsen, A. Sajedieh, F. Petersen, and J. Fischer Hansen Value of left ventricular filling parameters to predict mortality and functional class in patients with heart disease from the community Eur J Echocardiogr, March 1, 2005; 6(2): 85 - 91. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. Hay, J. Rich, P. Ferber, D. Burkhoff, and M. S. Maurer Role of impaired myocardial relaxation in the production of elevated left ventricular filling pressure Am J Physiol Heart Circ Physiol, March 1, 2005; 288(3): H1203 - H1208. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N Wisniacki, W Taylor, M Lye, and J P H Wilding Insulin resistance and inflammatory activation in older patients with systolic and diastolic heart failure Heart, January 1, 2005; 91(1): 32 - 37. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. K. Hamlin, P. S. Villars, J. T. Kanusky, and A. D. Shaw Role of Diastole in Left Ventricular Function, II: Diagnosis and Treatment Am. J. Crit. Care., November 1, 2004; 13(6): 453 - 466. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. S. Maurer, D. Spevack, D. Burkhoff, and I. Kronzon Diastolic dysfunction: Can it be diagnosed by Doppler echocardiography? J. Am. Coll. Cardiol., October 19, 2004; 44(8): 1543 - 1549. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. Hashimoto, A. H. Bhat, X. Li, M. Jones, C. H. Davies, J. C. Swanson, S. T. Schindera, and D. J. Sahn Tissue Doppler-derived myocardial acceleration for evaluation of left ventricular diastolic function J. Am. Coll. Cardiol., October 6, 2004; 44(7): 1459 - 1466. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Steendijk Heart failure with preserved ejection fraction. Diastolic dysfunction, subtle systolic dysfunction, systolic-ventricular and arterial stiffening, or misdiagnosis? Cardiovasc Res, October 1, 2004; 64(1): 9 - 11. [Full Text] [PDF]
|
|
|
|
|
|
G. P. Aurigemma and W. H. Gaasch Diastolic Heart Failure N. Engl. J. Med., September 9, 2004; 351(11): 1097 - 1105. [Full Text] [PDF]
|
|
|
|
|
|
M. S. Maurer, M. Packer, D. Burkhoff, D. L. King, M. Grieff, M. R. Zile, C. F. Baicu, W. H. Gaasch, and M. M. Redfield Diastolic Heart Failure N. Engl. J. Med., September 9, 2004; 351(11): 1143 - 1145. [Full Text] [PDF]
|
|
|
|
|
|
P. M. Mottram, B. Haluska, R. Leano, D. Cowley, M. Stowasser, and T. H. Marwick Effect of Aldosterone Antagonism on Myocardial Dysfunction in Hypertensive Patients With Diastolic Heart Failure Circulation, August 3, 2004; 110(5): 558 - 565. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. J. Adams, S. R. Lipsitz, S. D. Colan, N. J. Tarbell, S. T. Treves, L. Diller, N. Greenbaum, P. Mauch, and S. E. Lipshultz Cardiovascular Status in Long-Term Survivors of Hodgkin's Disease Treated With Chest Radiotherapy J. Clin. Oncol., August 1, 2004; 22(15): 3139 - 3148. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. A. Kass, J. G.F. Bronzwaer, and W. J. Paulus What Mechanisms Underlie Diastolic Dysfunction in Heart Failure? Circ. Res., June 25, 2004; 94(12): 1533 - 1542. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Dokainish, W. A. Zoghbi, N. M. Lakkis, F. Al-Bakshy, M. Dhir, M. A. Quinones, and S. F. Nagueh Optimal Noninvasive Assessment of Left Ventricular Filling Pressures: A Comparison of Tissue Doppler Echocardiography and B-Type Natriuretic Peptide in Patients With Pulmonary Artery Catheters Circulation, May 25, 2004; 109(20): 2432 - 2439. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. R. Zile, C. F. Baicu, and W. H. Gaasch Diastolic Heart Failure -- Abnormalities in Active Relaxation and Passive Stiffness of the Left Ventricle N. Engl. J. Med., May 6, 2004; 350(19): 1953 - 1959. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M C Petrie, K Hogg, L Caruana, and J J V McMurray Poor concordance of commonly used echocardiographic measures of left ventricular diastolic function in patients with suspected heart failure but preserved systolic function: is there a reliable echocardiographic measure of diastolic dysfunction? Heart, May 1, 2004; 90(5): 511 - 517. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Klapholz, M. Maurer, A. M. Lowe, F. Messineo, J. S. Meisner, J. Mitchell, J. Kalman, R. A. Phillips, R. Steingart, E. J. Brown Jr, et al. Hospitalization for heart failure in the presence of a normal left ventricular ejection fraction: Results of the New York heart failure registry J. Am. Coll. Cardiol., April 21, 2004; 43(8): 1432 - 1438. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. J. Skaluba and S. E. Litwin Mechanisms of Exercise Intolerance: Insights From Tissue Doppler Imaging Circulation, March 2, 2004; 109(8): 972 - 977. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Mueller, A. Scholer, K. Laule-Kilian, B. Martina, C. Schindler, P. Buser, M. Pfisterer, and A. P. Perruchoud Use of B-Type Natriuretic Peptide in the Evaluation and Management of Acute Dyspnea N. Engl. J. Med., February 12, 2004; 350(7): 647 - 654. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. K. Gehlbach and E. Geppert The Pulmonary Manifestations of Left Heart Failure Chest, February 1, 2004; 125(2): 669 - 682. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Yamaguchi, J. Yoshida, K. Yamamoto, Y. Sakata, T. Mano, N. Akehi, M. Hori, Y.-J. Lim, M. Mishima, and T. Masuyama Elevation of plasma brain natriuretic peptide is a hallmark of diastolic heart failure independent of ventricular hypertrophy J. Am. Coll. Cardiol., January 7, 2004; 43(1): 55 - 60. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. S Vasan Diastolic heart failure BMJ, November 22, 2003; 327(7425): 1181 - 1182. [Full Text] [PDF]
|
|