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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Assistant Editor(s)-in-Chief: Rim Halaby
Overview
The evaluation of the presence of diastolic dysfunction in patients presenting with symptoms of heart failure is of paramount importance. The diagnosis of diastolic dysfunction or diastolic heart failure is not clinical and requires a work up that goes beyond the history, physical exam, echocardiography and chest X-rays. Several studies have evaluated the diagnostic criteria to follow in differentiating systolic dysfunction from diastolic dysfunction.
Diagnostic Criteria
The diagnostic criteria published by the Working Study Group for the European Society of Cardiology in 1998 included three obligatory conditions for the diagnosis of diastolic heart failure:
- 1- Signs or symptoms of heart failure:
- Dyspnea, orthopnea, pulmonary rales
- 2- Normal or mildly abnormal systolic left ventricular (LV) function:
- LVEF > 50% and an LV end-diastolic volume index (LVEDVI) <97 mL/m2)
- 3- Evidence of diastolic LV dysfunction:
- IVRT: <30 years > 92 ms; 30–50 years > 100 ms; >50 years > 105 msc
- E/A<1 + DT>220 ms + S/D<1.5 <50 years
- E/A<0.5 + DT>280 msec + S/S>2.5 >-50 years[1]
To note that: DT = deceleration time of E velocity, E/A = ratio of early diastolic velocity to atrial velocity, EF = ejection fraction, HF = heart failure, IVRT = isovolumic relaxation time, LV = left ventricular, LVIDDi = left ventricular internal diastolic diameter index, S/D = ratio of systolic to diastolic velocity of venous pulmonary veins.
Other studies have suggested some refinements in the diagnostic criteria of diastolic heart failure:
- Zile et al concluded in their study entitled “Heart failure with a normal ejection fraction: is measurement of diastolic function necessary to make the diagnosis of diastolic heart failure?” that the diagnosis of heart failure can be established without the invasive evaluation of diastolic function. It was suggested that two criteria, if present, are enough for the diagnosis:
- Symptoms and signs of heart failure
- Left ventricular ejection fraction >50%[2]
- Gandi et al, in their study “The pathogenesis of acute pulmonary edema associated with hypertension“, suggested that the diagnosis of diastolic heart failure can be done when the ejection fraction is >50% within 72 hours of the onset of congestive heart failure symptoms (with the exception of acute ischemia). [3]
References
- ↑ European study Group on Diastolic Heart Failure. How to diagnose diastolic heart failure. Eur Heart J 1998;19:990-1003.
- ↑ Zile MR, Gaasch WH, Carroll JD, et al. Heart failure with a normal ejection fraction: is measurement of diastolic function necessary to make the diagnosis of diastolic heart failure? Circulation. 2001; 104: 779–782.
- ↑ Gandi SK, Powers JC, Nomeir A, et al. The pathogenesis of acute pulmonary edema associated with hypertension. N Engl J Med. 2001; 344: 17–60.