doi: 10.1161/01.CIR.0000053947.82595.03
(Circulation. 2003;107:656.)
© 2003 American Heart Association, Inc.
Editorial |
Heart Failure With a Normal Ejection Fraction
Is It Really a Disorder of Diastolic Function?
From the Divisions of Circulatory Physiology and Cardiology, Columbia University College of Physicians and Surgeons, New York, NY.
Correspondence to Daniel Burkhoff, MD, PhD, Columbia University College of Physicians and Surgeons, Black Building 812, 650 W 168th St, New York, NY 10032. E-mail db59@columbia.edu
Key Words: Editorials • heart failure • diastole
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
A large proportion of patients who present with symptoms of heart failure have a left ventricular ejection fraction within the normal range.1 Although some have postulated that ventricular systolic function is impaired,2 most investigators have concluded that the fundamental abnormality in these patients is a disorder of diastolic (rather than systolic) function,3–5 and in fact, these patients are frequently referred to as having diastolic heart failure. The use of such a term is troublesome, however, because it presumes that we understand the mechanisms leading to this disorder and therefore can justify the substitution of a mechanistic term for a descriptive phrase. A less presumptuous approach is to refer to these patients as having heart failure with a normal ejection fraction (HFNEF), a descriptive approach that makes no assumptions about our knowledge about the pathophysiology of this disorder.
See p 714
Do most patients with heart failure and a normal ejection fraction have diastolic dysfunction? Patients with HFNEF are generally elderly women who have associated hypertension, diabetes, and/or coronary artery disease.6 These comorbid conditions have been linked to myocardial hypertrophy, ischemia, and/or interstitial fibrosis, each of which can prolong relaxation and increase passive myocardial stiffness.7 However, the coexistence of disorders known to affect these aspects of diastole is not sufficient to establish that diastolic dysfunction is the cause of heart failure when it occurs in patients with a normal ejection fraction. To determine that an abnormality of diastolic function is the cause of the patient’s symptoms, we need to demonstrate the
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Circulation 2003 107: 714-720.
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