Circulation. 2001;104:779-782
doi: 10.1161/hc3201.094226
doi: 10.1161/hc3201.094226
(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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B. M. Massie Natriuretic peptide measurements for the diagnosis of "nonsystolic" heart failure: Good news and bad J. Am. Coll. Cardiol., June 4, 2003; 41(11): 2018 - 2021. [Full Text] [PDF]
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M. R. Zile Heart failure with preserved ejection fraction: is this diastolic heart failure? J. Am. Coll. Cardiol., May 7, 2003; 41(9): 1519 - 1522. [Full Text] [PDF]
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D. Burkhoff, M. S. Maurer, and M. Packer Heart Failure With a Normal Ejection Fraction: Is It Really a Disorder of Diastolic Function? Circulation, February 11, 2003; 107(5): 656 - 658. [Full Text] [PDF]
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M. Kawaguchi, I. Hay, B. Fetics, and D. A. Kass Combined Ventricular Systolic and Arterial Stiffening in Patients With Heart Failure and Preserved Ejection Fraction: Implications for Systolic and Diastolic Reserve Limitations Circulation, February 11, 2003; 107(5): 714 - 720. [Abstract] [Full Text] [PDF]
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D. G Gibson and D. P Francis CLINICAL ASSESSMENT OF LEFT VENTRICULAR DIASTOLIC FUNCTION Heart, February 1, 2003; 89(2): 231 - 238. [Full Text] [PDF]
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M. Jessup The less familiar face of heart failure J. Am. Coll. Cardiol., January 15, 2003; 41(2): 224 - 226. [Full Text] [PDF]
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 M. M. Redfield, S. J. Jacobsen, J. C. Burnett Jr, D. W. Mahoney, K. R. Bailey, and R. J. Rodeheffer Burden of Systolic and Diastolic Ventricular Dysfunction in the Community: Appreciating the Scope of the Heart Failure Epidemic JAMA, January 8, 2003; 289(2): 194 - 202. [Abstract] [Full Text] [PDF]
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 A. U. Syed, W. L. Border, E. C. Michelfelder, P. B. Manning, and J. M. Pearl Pancreatitis in Fontan patients is related to impaired ventricular relaxation Ann. Thorac. Surg., January 1, 2003; 75(1): 153 - 157. [Abstract] [Full Text] [PDF]
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D. W. Kitzman, W. C. Little, P. H. Brubaker, R. T. Anderson, W. G. Hundley, C. T. Marburger, B. Brosnihan, T. M. Morgan, and K. P. Stewart Pathophysiological Characterization of Isolated Diastolic Heart Failure in Comparison to Systolic Heart Failure JAMA, November 6, 2002; 288(17): 2144 - 2150. [Abstract] [Full Text] [PDF]
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A. Cohen-Solal Diastolic heart failure: myth or reality? Eur J Heart Fail, August 1, 2002; 4(4): 395 - 400. [Full Text] [PDF]
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C. A. Pierach, M. R. Zile, W. H. Gaasch, J. D. Carroll, M. D. Feldman, G. P. Aurigemma, G. L. Schaer, P. R. Liebson, and J. K. Ghali Looking for Diastolic Dysfunction * Response Circulation, June 11, 2002; 105 (23): e189 - e189. [Full Text] [PDF]
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M. R. Zile and D. L. Brutsaert New Concepts in Diastolic Dysfunction and Diastolic Heart Failure: Part I: Diagnosis, Prognosis, and Measurements of Diastolic Function Circulation, March 19, 2002; 105(11): 1387 - 1393. [Full Text] [PDF]
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Y. Agmon, J. Lessick, S. A. Reisner, M. R. Zile, W. H. Gaasch, J. D. Carroll, M. D. Feldman, G. P. Aurigemma, G. L. Schaer, P. R. Liebson, et al. Heart Failure With a Normal Ejection Fraction Response Circulation, February 12, 2002; 105 (6): e48 - e48. [Full Text] [PDF]
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