Which echocardiographic parameters do we need for the diagnostics of primary diastolic heart failure?

Abstract

Aim: The European Society of Cardiology (ESC) published a consensus statement on the diagnosis of diastolic heart failure (heart failure with normal ejection fraction, HFNEF) in 2007. The aim of this study was to assess the occurrence of HFNEF in patients with normal left ventricular ejection fraction (LV EF) suffering from exertional dyspnea of unknown etiology and to determine the proportion of individual clinical and echocardiographic parameters used in the diagnostics of HFNEF according to the consensus of ESC. Methods: Seventy patients with exertional dyspnea of unknown etiology were investigated according to the consensus of ESC. They underwent coronary angiography, spirometry, laboratory (including NT-proBNP), electrocardiographic and echocardiographic examinations. Results: Twenty-three (33%) patients met the criteria for the diagnosis of HFNEF, while the remaining 47 (67%) patients did not. The maximal applicability for the diagnostics of HFNEF was found for the ratio of early diastolic velocity of LV filling (E) to the early diastolic velocity of mitral annular motion (Ea) and for the assessment of plasma level of NT-proBNP, which were suggestive of HFNEF in 22 (96%) and 19 (83%) patients, respectively. On the other hand, values of the ratio of early to late transmitral LV filling (E/A) and deceleration time of E wave (DT) suggestive of HFNEF were found in no patients with this diagnosis. Conclusion: Comprehensive approach including echocardiography, electrocardiography, and plasma level of NT-proBNP assessment allows the non-invasive diagnostics of HFNEF in a significant proportion of patients with exertional dyspnea of unknown etiology. Doppler LV filling parameters in values recommended by ESC do not contribute to the diagnostics of HFNEF.