CARDIOVASCULAR MEDICINE

Echocardiographic features and brain natriuretic peptides in patients presenting with heart failure and preserved systolic function

M D Thomas, K F Fox, D A Wood, J S R Gibbs, A J S Coats, M Y Henein, P A Poole-Wilson, G C Sutton

Cardiovascular Medicine, National Heart and Lung Institute, Imperial College, London, UK

Correspondence to:
Dr Martin D Thomas
Cardiovascular Medicine, National Heart and Lung Institute, Imperial College, 5th Floor, Lab Block, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK; thomasmd{at}globalnet.co.uk

Objective: To characterise patients who appear to fulfil the diagnosis of heart failure with preserved systolic function clinically, echocardiographically, and by concentrations of brain-type natriuretic peptide (BNP).

Methods: 102 new cases of heart failure were identified over 24 months in 213 patients referred to a rapid access heart failure clinic. Patients with heart failure and preserved systolic function with contemporary markers of diastolic function were assessed to evaluate their cardiac status further.

Results: Forty patients (39%) had an ejection fraction (EF) < 45% and 62 (61%) had an EF 45%. Of these 62 patients, 30 (48%) fulfilled the case definition of diastolic heart failure. The remaining 32 (52%) had neither an EF < 45% nor abnormalities of diastolic function. Dobutamine stress echocardiography was performed on 26 (42%) patients with EF 45%, which provided an alternative explanation for symptoms in 15 (58%) patients. Concentrations of BNP were higher in patients with diastolic abnormalities (mean (SEM) 101.4 (32.5) pg/ml v 58.4 (6.78) pg/ml, p = 0.042) and with no diastolic abnormalities (199 (37.9) pg/ml v 58.4 (6.78) pg/ml, p < 0.0001) than in patients with no heart failure.

Conclusion: Among ambulatory patients presenting with suspected heart failure in the community 19% have systolic dysfunction, 14% have diastolic dysfunction, and 15% seemingly have heart failure with neither systolic nor diastolic dysfunction. A new understanding, including alternative parameters of diastolic function, seems to be necessary to classify patients with heart failure and preserved systolic function.

Abbreviations: BNP, brain-type natriuretic peptide; EF, ejection fraction; ESC, European Society of Cardiology; RAHFC, rapid access heart failure clinic

Keywords: heart failure; echocardiography; diastolic function; stress echocardiography; brain natriuretic peptide

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