How to diagnose diastolic heart failure

A consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology

Walter J. Paulus, Carsten Tschöpe, John E. Sanderson, Cesare Rusconi, Frank A. Flachskampf, Frank E. Rademakers, Paolo Marino, Otto A. Smiseth, Gilles De Keulenaer, Adelino F. Leite-Moreira, A. Borbély, I. Édes, Martin Louis Handoko, Stephane Heymans, Natalia Pezzali, Burkert Pieske, Kenneth Dickstein, Alan G. Fraser, Dirk L. Brutsaert

Research output: Contribution to journalArticle

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Abstract

Diastolic heart failure (DHF) currently accounts for more than 50% of all heart failure patients. DHF is also referred to as heart failure with normal left ventricular (LV) ejection fraction (HFNEF) to indicate that HFNEF could be a precursor of heart failure with reduced LVEF. Because of improved cardiac imaging and because of widespread clinical use of plasma levels of natriuretic peptides, diagnostic criteria for HFNEF needed to be updated. The diagnosis of HFNEF requires the following conditions to be satisfied: (i) signs or symptoms of heart failure; (ii) normal or mildly abnormal systolic LV function; (iii) evidence of diastolic LV dysfunction. Normal or mildly abnormal systolic LV function implies both an LVEF > 50% and an LV end-diastolic volume index (LVEDVI) 2. Diagnostic evidence of diastolic LV dysfunction can be obtained invasively (LV end-diastolic pressure >16 mmHg or mean pulmonary capillary wedge pressure >12 mmHg) or non-invasively by tissue Doppler (TD) (E/E′ > 15). If TD yields an E/E′ ratio suggestive of diastolic LV dysfunction (15 > E/E′ > 8), additional non-invasive investigations are required for diagnostic evidence of diastolic LV dysfunction. These can consist of blood flow Doppler of mitral valve or pulmonary veins, echo measures of LV mass index or left atrial volume index, electrocardiographic evidence of atrial fibrillation, or plasma levels of natriuretic peptides. If plasma levels of natriuretic peptides are elevated, diagnostic evidence of diastolic LV dysfunction also requires additional non-invasive investigations such as TD, blood flow Doppler of mitral valve or pulmonary veins, echo measures of LV mass index or left atrial volume index, or electrocardiographic evidence of atrial fibrillation. A similar strategy with focus on a high negative predictive value of successive investigations is proposed for the exclusion of HFNEF in patients with breathlessness and no signs of congestion. The updated strategies for the diagnosis and exclusion of HFNEF are useful not only for individual patient management but also for patient recruitment in future clinical trials exploring therapies for HFNEF.

Original languageEnglish
Pages (from-to)2539-2550
Number of pages12
JournalEuropean Heart Journal
Volume28
Issue number20
DOIs
Publication statusPublished - Oct 2007

Fingerprint

Diastolic Heart Failure
Left Ventricular Dysfunction
Stroke Volume
Echocardiography
Heart Failure
Natriuretic Peptides
Pulmonary Veins
Mitral Valve
Left Ventricular Function
Atrial Fibrillation
Pulmonary Wedge Pressure
Dyspnea
Patient Selection
Signs and Symptoms
Clinical Trials
Blood Pressure

Keywords

  • Diastole
  • Ejection fraction
  • Heart failure
  • Natriuretic peptides
  • Tissue doppler

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

How to diagnose diastolic heart failure : A consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology. / Paulus, Walter J.; Tschöpe, Carsten; Sanderson, John E.; Rusconi, Cesare; Flachskampf, Frank A.; Rademakers, Frank E.; Marino, Paolo; Smiseth, Otto A.; De Keulenaer, Gilles; Leite-Moreira, Adelino F.; Borbély, A.; Édes, I.; Handoko, Martin Louis; Heymans, Stephane; Pezzali, Natalia; Pieske, Burkert; Dickstein, Kenneth; Fraser, Alan G.; Brutsaert, Dirk L.

In: European Heart Journal, Vol. 28, No. 20, 10.2007, p. 2539-2550.

Research output: Contribution to journalArticle

Paulus, WJ, Tschöpe, C, Sanderson, JE, Rusconi, C, Flachskampf, FA, Rademakers, FE, Marino, P, Smiseth, OA, De Keulenaer, G, Leite-Moreira, AF, Borbély, A, Édes, I, Handoko, ML, Heymans, S, Pezzali, N, Pieske, B, Dickstein, K, Fraser, AG & Brutsaert, DL 2007, 'How to diagnose diastolic heart failure: A consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology', European Heart Journal, vol. 28, no. 20, pp. 2539-2550. https://doi.org/10.1093/eurheartj/ehm037
Paulus, Walter J. ; Tschöpe, Carsten ; Sanderson, John E. ; Rusconi, Cesare ; Flachskampf, Frank A. ; Rademakers, Frank E. ; Marino, Paolo ; Smiseth, Otto A. ; De Keulenaer, Gilles ; Leite-Moreira, Adelino F. ; Borbély, A. ; Édes, I. ; Handoko, Martin Louis ; Heymans, Stephane ; Pezzali, Natalia ; Pieske, Burkert ; Dickstein, Kenneth ; Fraser, Alan G. ; Brutsaert, Dirk L. / How to diagnose diastolic heart failure : A consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology. In: European Heart Journal. 2007 ; Vol. 28, No. 20. pp. 2539-2550.
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