The epidemiological enigma of heart failure with preserved systolic function

Abstract

Background: Current epidemiological evidence suggests that the prevalence of preserved systolic function in patients with heart failure varies widely from 13 to 74%. This inconsistency suggests a lack of consensus as to what this condition really is and how it has been characterised for epidemiological studies. Aims: In this review, we summarise and discuss the current understanding of the epidemiology of heart failure with preserved systolic function and the challenges that this raises. Methods: Studies were identified from Medline and Embase Literature Database searches using the subject headings heart failure, diastolic heart failure, epidemiology, incidence, prevalence, diagnosis, prognosis and mortality. Results: Sixty-one studies of congestive heart failure with preserved systolic function were reviewed. There is great diversity in the criteria used to determine whether heart failure is present, the patient population, the setting of the study and methods of evaluating left ventricular function. This makes epidemiological studies of prevalence, morbidity and mortality impossible to compare. Conclusions: The diagnosis of this syndrome might be better defined in terms of symptoms, elevated neuro hormones and impaired cardiac workload. This would allow accurate identification of cases so that further research could be conducted to measure outcome and assess therapeutic benefit.

The Natural History of Preclinical Diastolic Dysfunction: A Population Based Study

“…[2][3][4][5][6][7][8][9] In the AHA/ACCF classification of HF, stage B is defined as structural heart disease without signs/symptoms of HF. 10 Preclinical diastolic dysfunction (PDD), which is part of Stage B HF, has therefore been defined as patients with diastolic dysfunction (DD), normal EF, and without HF symptoms/diagnosis.…”

Office management of patients with diastolic heart failure

“…12 Identifying high-quality, uniform studies of diastolic heart failure on which to base precise conclusions regarding prevalence, risk factors and prognosis is therefore difficult. 8 To deal with this deficiency, reviews of primary studies most often report mean estimates with wide ranges and include a call for further studies.…”

“…1 This reflects a presumption that patients with heart failure and preserved ejection fraction have diastolic dysfunction even in the absence of evidence from an objective assessment of left ventricular function. 8 The question of whether diastolic abnormalities must be proven before making a diagnosis of diastolic heart failure is debatable. What the best modality of cardiac imaging is to accomplish this is also debatable.…”

“…2,4 Near normal, however, can include ejection fractions ranging from 35% to 55% depending on the source. 2,8 Various groups have proposed criteria for the diagnosis of diastolic heart failure. 5,[9][10][11] All acknowledge that the condition cannot be distinguished from systolic heart failure on the basis of symptoms, physical examination, chest radiography or electrocardiography.…”

Incidence of chronic heart failure with preserved left ventricular ejection fraction in patients with hypertension and isolated mild diastolic dysfunction

“…Continuous variables were first evaluated for normal coronary artery disease (CAD), hypertrophic cardiomyopathy, congenital heart defects associated with ventricular hypertrophy, and diabetes. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] According to the European Society of Cardiology (ESC), the diagnosis of HFPEF requires 4 criteria to be met: the presence of signs and symptoms typical of HF, normal or only mildly reduced LVEF, no LV dilation, and relevant structural heart disease or left ventricular diastolic dysfunction (or both).…”