Diagnosis of heart failure with preserved ejection fraction: role of clinical Doppler echocardiography
- Department of Cardiology, Cardiovascular Center Aalst, Aalst, Belgium
- Correspondence to Dr Martin Penicka, Department of Cardiology, Cardiovascular Center, Moorselbaan 164, Aalst 9300, Belgium;
In developed countries, at least 38–54% of patients with heart failure show preserved left ventricular (LV) ejection fraction.1–3 The prevalence of heart failure with preserved ejection fraction (HFPEF) is steadily increasing and its prognosis is poor.1–3 LV diastolic dysfunction, either alone or in combination with other factors (figure 1), is the major underlying mechanism of HFPEF.3–5 In the general population, the presence of even mild clinical diastolic dysfunction has been associated with pronounced increases in all cause mortality.6 Hence, the diagnosis of clinical (prognostic) diastolic dysfunction leading to HFPEF is of critical importance.
The European Society of Cardiology guidelines based definition of HFPEF requires a presence of signs and symptoms of heart failure, preserved LV ejection fraction of a non-dilated left ventricle, and evidence of diastolic dysfunction (impaired LV relaxation or increased LV diastolic stiffness) with elevated LV filling pressures.3 LV diastolic dysfunction and filling pressures can be assessed non-invasively using Doppler echocardiography.7 This article will focus on the clinical use of Doppler echocardiography in the diagnosis of …