Heart failure with a normal ejection fraction - Is measurement of diastolic function necessary to make the diagnosis of diastolic heart failure?

Background-The diagnosis of diastolic heart failure is generally made in pa tients who have the signs and symptoms of heart failure and a normal left v entricular (LV) ejection fraction. Whether the diagnosis also requires an o bjective measurement of parameters that reflect the diastolic properties of the ventricle has not been established. Methods and Results-We hypothesized that the vast majority of patients with heart failure and a normal ejection fraction exhibit abnormal LV diastolic function. We tested this hypothesis by prospectively identifying 63 patien ts with a history of heart failure and an echocardiogram suggesting LV hype rtrophy and a normal ejection fraction; we then assessed LV diastolic funct ion during cardiac catheterization. All 63 patients had standard hemodynami c measurements; 47 underwent detailed micromanometer and echocardiographic- Doppler studies. The LV end-diastolic pressure was > 16 mm. Hg in 58 of the 63 patients; thus, 92% had elevated end-diastolic pressure (average, 24 +/ - 8 mm. Hg). The time constant of LV relaxation (average, 51 +/- 15 ms) was abnormal in 79% of the patients. The E/A ratio was abnormal in 48% of the patients. The E-wave deceleration time (average, 349 +/- 140 ms) was abnorm al in 64% of the patients. One or more of the indexes of diastolic function were abnormal in every patient. Conclusions-Objective measurement of LV diastolic function serves to confir m rather than establish the diagnosis of diastolic heart failure. The diagn osis of diastolic heart failure can be made without the measurement of para meters that reflect LV diastolic function.