Heart failure with preserved ejection fraction

Abstract

of the endocardium without the use of intravenous contrast is lacking, 5 the cut-off value of 50% for LVEF to dichotomize HFPEF from HF with reduced ejection fraction (HFREF) is somewhat arbitrary. Maybe the simultaneous use of 2 methods, namely, echocardiography, which is more precise for LV diastolic dysfunction assessment, and cardiac magnetic resonance (CMR), which is better for systolic dysfunction evaluation, is the optimal solution, as proposed by Leong et al. 6 What is established for now, the characterization of HF patients should be as wide as possible, including (except for certain clinical examinations) additional tests described by Brzyżkiewicz et al 1 such as echocardiography, chest X-ray, and laboratory tests with special attention to HF-specific natriuretic peptides. A wide spectrum of diagnostic tests not only dedicated to HF is especially important in patients with HFPEF, where differential diagnosis is pivotal.The above considerations lead to a conclusion that diagnosis and, in consequence, the real prevalence of HFPEF are not so easy to establish. The estimate indicates that the prevalence of HFPEF among patients with HF might be about 54%, ranging from 40% to 71%, 7 which is in agreement with the results of one of the largest trials, the Copenhagen Hospital Heart Failure Study, in which the prevalence of HFPEF was 61%.8 Data from the National Health and Nutrition Examination Survey (NHANES) suggest an increase of 46% in the prevalence of HFPEF by 2030. 9 In clinical practice, an echocardiographic examination is crucial for the determination of the fourth condition in HFPEF, namely, "relevant structural heart disease (LV hypertrophy/left atrial enlargement) and/or diastolic dysfunction". 2 The recommendations of American and European echocardiography societies 10 as well as the ESC guidelines for the diagnosis and treatment of acute and chronic HF 2 agree that a good definition of LV diastolic dysfunction needs to evaluate more than 1 group of indices. The echocardiographic techniques to assess LV systolic and diastolic function have evolved rapidly over the past years. New techniques of tissue Doppler Diastolic heart failure is a disorder characterized by impaired left ventricular (LV) relaxation and increased LV stiffness. Heart failure with preserved ejection fraction (HFPEF) accounts for 40% to 50% of all HF cases and has a prognosis that is as dangerous as that of systolic HF. 1,2 Nowadays, HF is growing into a major health problem, so that recent HF guidelines have placed special emphasis on the detection of LV systolic and diastolic dysfunction and the timely identification of risk factors for HF.1 Therefore, the issue addressed in the article of Brzyżkiewicz et al 1 is particularly important. The authors aimed to evaluate the prevalence of HF diagnosis in hypertensive patients with the first stage of diastolic dysfunction, namely, impaired relaxation. They based the diagnosis of HFPEF on the 2012 European Society of Cardiology (ESC) guidelines, 2 which require 4 conditions to be ful...