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Heart 100:68-76 doi:10.1136/heartjnl-2011-301321
  • Education in Heart
  • Heart failure

Diagnosis of heart failure with preserved ejection fraction: role of clinical Doppler echocardiography

  1. Jozef Bartunek
  1. Department of Cardiology, Cardiovascular Center Aalst, Aalst, Belgium
  1. Correspondence to Dr Martin Penicka, Department of Cardiology, Cardiovascular Center, Moorselbaan 164, Aalst 9300, Belgium; Martin.Penicka{at}olvz-aalst.be

In developed countries, at least 38–54% of patients with heart failure show preserved left ventricular (LV) ejection fraction.13 The prevalence of heart failure with preserved ejection fraction (HFPEF) is steadily increasing and its prognosis is poor.13 LV diastolic dysfunction, either alone or in combination with other factors (figure 1), is the major underlying mechanism of HFPEF.35 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.

Figure 1

Causes of heart failure with preserved ejection fraction (HFPEF). Diastolic dysfunction is present in the majority of patients with HFPEF and thus it can be viewed as a marker of HFPEF. Diastolic dysfunction is a sensitive rather than a specific index of HFPEF. In other words, in the absence of diastolic dysfunction the diagnosis of HFPEF is less likely. Several studies have demonstrated a potential role of other cardiac and non-cardiac abnormalities in the pathogenesis of HFPEF. Of note, HFPEF is a disease associated with old age and therefore there is a high prevalence of other, non-cardiac, comorbidities (upper right corner). This makes the differential diagnosis of dyspnoea in the elderly quite challenging. COPD, chronic obstructive pulmonary disease; Hb, haemoglobin.

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 …