Characteristic Features of Heart Failure with Preserved Left Ventricle Systolic Function
Abstract
Heart Failure (HF) is a syndrome that affects approximately 2-3% of the general population. The prevalence of HF rises sharply after 75 years of age, reaching 10 to 20% for people aged 70-80 years. As it affects about 14 million Europeans, HF represents a major public health problem.
HF may be caused by altered systolic or diastolic function or both. HF with preserved ejection fraction (EF) occurs in half the patients with HF. Though it would be expected that the prognosis to be better, it is essentially similar with the prognosis of the patients with systolic HF, which explains the interest for an early and accurate diagnosis of these conditions.
The patients with heart failure and preserved EF have comparable characteris- tics with the patients with heart failure and altered EF, such as reduced effort capacity, the association of neuroendocrine disturbances and altered life quality.
Routine clinical examination does not evidence the disturbed diastolic function of left ventricule. Therefore we have to use complementary examination, noninvasive (such as echocardiography) or/and invasive examination (such as cardiac catheterization) to establish diagnosis.
Comprehensive assessment of diastolic filling and estimation of filling pressures of the left ventricle (LV) requires the evaluation by Doppler echocardiography of mitral and pulmonary vein inflow velocities, by M mode color Doppler of left intraventricular inflow for propagation velocity, and tissue Doppler evaluation of the mitral ring. These techniques stand at the very base of assessment of diastolic function and they help establish a positive diagnosis and quantification of the LV dysfunction.
Early diagnosis of HF with preserved EF represents an indispensable condition to prevent the deterioration of the myocardial function. Current technical means allow this, and also make possible the monitoring and individualization of the therapy according to each patient.