Heart failure with normal left ventricular ejection fraction: Basic principles and clinical diagnostics

Abstract

Heart failure with normal left ventricular (LV) ejection fraction (HF-NEF), sometimes named diastolic heart failure, is a common condition, most frequent in the elderly and is associated with arterial hypertension and LV hypertrophy. Prognosis is almost as severe as for heart failure with reduced EF, in part reflecting comorbidities. Because the heart failure diagnosis is based on relatively nonspecific symptoms and signs, it is important to apply objective measures of diastolic function when evaluating patients with potential HF-NEF. In the absence of invasive data, this is done by echocardiography to demonstrate signs of impaired relaxation, increased diastolic stiffness, or elevated LV filling pressure. The echocardiographic measures include transmitral, pulmonary venous, and intraventricular flow velocities and estimation of systolic pulmonary artery pressure from tricuspid regurgitation velocity. In addition, LV lengthening velocity by tissue Doppler should be measured. It is important to search for consistency between measures since no single variable provides sufficient diagnostic information. Treatment of HF-NEF is symptomatic, with similar drugs as in heart failure with reduced EF.