Heart failure with a normal left ventricular ejection fraction: diastolic heart failure - PubMed (original) (raw)

. 2008:119:93-99; discussion 99-102.

Affiliations

Heart failure with a normal left ventricular ejection fraction: diastolic heart failure

William C Little. Trans Am Clin Climatol Assoc. 2008.

Abstract

A reduced left ventricular ejection fraction measured by echocardiography in a patient with clinical features of heart failure demonstrates that the patient has a cardiac abnormality and that the clinical picture is, in fact, due to heart failure. As such, a reduced ejection fraction (< 0.30 or 0.35) has been used as entry criteria for almost all the large clinical trials that guide our therapy of patients with heart failure. However, it has been recently recognized that a substantial and increasing proportion of patients with heart failure have a normal ejection fraction (> 0.50). Such patients are typically elderly women with systolic hypertension. These patients are subject to the sudden development of pulmonary congestion (flash pulmonary edema). The finding of heart failure in patients with a normal ejection fraction has focused attention on the role of diastolic dysfunction in producing symptomatic heart failure. The optimal treatment of patients with heart failure and normal ejection fraction has not yet been defined, but the control of systolic hypertension and the avoidance of fluid overload are important.

PubMed Disclaimer

Figures

Fig. 1

Fig. 1

Left ventricular ejection fraction on presentation with acute pulmonary edema and after treatment. The ejection fraction is similar in both circumstances. (Data from: Gandhi SK, Powers JC, Nomeir AM, Fowle K, Kitzman DW, Rankin KM, Little WC. The pathogenesis of acute pulmonary edema associated with hypertension. N Engl J Med 2001; 344:17–22.)

References

    1. Little WC. Hypertensive pulmonary oedema is due to diastolic dysfunction. Eur Heart J. 2001;22:1961–1964. - PubMed
    1. Gaasch WH, Little WC. Assessment of left ventricular diastolic function and recognition of diastolic heart failure. Circulation. 2007;2007:591–593. - PubMed
    1. Kitzman DW, Little WC, Brubaker PH, Anderson RT, Hundley WG, Stewart KP, Marburger CT, Brosnihan B, Morgan TM, Wesley DJ. Pathophysiological characterization of isolated diastolic heart failure in comparison to systolic heart failure. JAMA. 2002;288:2144–2150. - PubMed
    1. Fukuta H, Ohte N, Brucks S, Carr JJ, Little WC. Contribution of right-sided heart enlargement to cardiomegaly on chest roentgenogram in diastolic and systolic heart failure. Am J Cardiol. 2007;99:62–67. - PubMed
    1. Fukuta H, Little WC. Diastolic versus systolic heart failure. In: Smiseth OA, Tendera M, editors. Diastolic Heart Failure. London: Springer; 2007. in press.

Publication types

MeSH terms

LinkOut - more resources