SYSTOLIC AND DIASTOLIC DYSFUNCTION IN HEART FAILURE

Aim: The study was aimed to analyze systolic and diastolic dysfunction in patients with heart failure (HF).
Methods:  We enrolled 98 consecutive patients hospitalized for acute pulmonary edema. A dosage of N terminal pro-B type natriuretic peptide (NT pro-BNP) was performed. Each patients had an initial echocardiogram with evaluation of LVEF. All the patients with a LVEF > 45% underwent a precise evaluation of valve diseases, segmental wall motion, and Doppler analysis of diastolic function.
Results: Study patients were 47% males and 53 % females; mean age was 78, 55 % were > 80 year-old. Fifty-three % of them had a LVEF < 45% and 47% had a normal systolic function. Patients with a preserved LVEF were predominantly women (60%) and were older (mean age 81 vs 75). 27% had significant coronary artery disease with documented ischaemia or segmental akinesia, 36 % had severe valve disease (7 aortic stenosis, 3 aortic regurgitation, 6 mitral regurgitation), 20 % had paroxysmal or permanent atrial fibrillation, 4 % had severe bradycardia, 4% had hypertrophic obstructive cardiomyopathy; 1 patient with an initial diagnosis of acute pulmonary edema was finally shown to have severe pulmonary embolism. Finally, only 12 patients (12%) were found to have isolated diastolic dysfunction. NT pro-BNP levels were found more elevated in the low LVEF group (6511 pg/ml) than in the preserved LVEF group (3638-overall, 2373-isolated diastolic dysfunction), without statistical significance.
Conclusion: This study confirms that a preserved LVEF is a common finding among patients with acute CHF (47%), but also shows that in most cases an alternative explanation can be found, rather than pure diastolic dysfunction which is found in only 12% of cases. NT pro-BNP does not seem to be able to discriminate between different types of CHF.
Support by grant No MSM0021622402.