Heart Failure with a Normal Ejection Fraction

Abstract

It has been increasingly recognized that there are many patients, mainly elderly women, who have symptoms of heart failure but their hearts are not enlarged and echocardiography shows a relatively normal left ventricular ejection fraction. The label “Diastolic heart failure” was coined for this group of patients because it was considered that systolic function was normal in view of the ejection fraction and hence the problem must lie in diastole. However, it has become clear that systolic function is not entirely normal and recent work has demonstrated that in these patients abnormalities exist in left ventricular systolic properties, ventricular-arterial coupling, LV diastolic function, torsion, ventricular−ventricular interaction and pericardial constraint, and other factors such as pulmonary hypertension, impaired chronotropic, vasodilator, and contractile reserves may contribute to the pathophysiology. Thus, the more simple label “heart failure with a normal ejection fraction” or HFNEF is the preferred term to diastolic heart failure (DHF), which implies that the primary or dominant abnormality is in diastole, and as it appears that the problem is not due to diastolic dysfunction only, the label HFNEF is more appropriate, which makes no assumptions about the causation of the condition.