Do patients with suspected heart failure and preserved left ventricular systolic function suffer from "diastolic heart failure" or from misdiagnosis?A prospective descriptive study

Objectives To characterise the clinical features of patients with suspected heart failure but preserved left ventricular systolic function to determin e if they have other potential causes for their symptoms rather than being diagnosed with "diastolic heart failure." Design Prospective descriptive study. Setting Outpatient based direct access echocardiography service. Participants 159 consecutive patients with suspected heart failure referred by general practitioners. Main outcome measures Symptoms (including shortness of breath, ankle oedema , and paroxysmal nocturnal dyspnoea) and history of coronary heart disease and chronic pulmonary disease. Transthoracic echocardiography, body mass in dex, pulmonary function tests, and electrocardiography. Results 109 of 159 participants had suspected heart failure in the absence of left ventricular systolic dysfunction, valvular heart disease, or atrial fibrillation. Of these 109, 40 were either obese or very obese, 54 had a r eduction in forced expiratory volume in 1 second to less than or equal to 7 0%, and 97 had a peak expiratory flow rate less than or equal to 70% of nor mal. Thirty one patients had a history of angina, 12 had had a myocardial i nfarction, and seven had undergone a coronary artery bypass graft. Only sev en patients lacked a recognised explanation for their symptoms. Conclusions For most patients with a diagnosis of heart failure but preserv ed left ventricular systolic function there is an alternative explanation f or their symptoms-for example, obesity, lung disease, and myocardial ischae mia-and the diagnosis of diastolic heart failure is rarely needed These alt ernative diagnoses should be rigorously sought and managed accordingly.