Echocardiographic features and brain natriuretic peptides in patients presenting with heart failure and preserved systolic function

• Published in: Heart (British Cardiac Society) 2006-05, Vol.92 (5), p.603-608
• Main Authors: Thomas, M D, Fox, K F, Wood, D A, Gibbs, J S R, Coats, A J S, Henein, M Y, Poole-Wilson, P A, Sutton, G C
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Beta blockers; Biological and medical sciences; BNP; brain natriuretic peptide; brain-type natriuretic peptide; Cardiac Output, Low - diagnosis; Cardiac Output, Low - diagnostic imaging; Cardiology; Cardiology. Vascular system; Cardiovascular Medicine; diastolic function; echocardiography; Echocardiography, Stress; ejection fraction; ESC; European Society of Cardiology; Family physicians; Female; Heart; Heart attacks; Heart failure; Heart Failure - diagnosis; Heart Failure - diagnostic imaging; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Humans; Male; Medical sciences; Methods; Middle Aged; Natriuretic Peptide, Brain - metabolism; Patients; Pilot Projects; Primary care; RAHFC; rapid access heart failure clinic; stress echocardiography; Stroke Volume; Studies; Surveillance; Systole; Ventricular Dysfunction, Left - diagnosis; Ventricular Dysfunction, Left - diagnostic imaging
• ISSN: 1355-6037; 1468-201X
• DOI: 10.1136/hrt.2005.063768

Objective: To characterise patients who appear to fulfil the diagnosis of heart failure with preserved systolic function clinically, echocardiographically, and by concentrations of brain-type natriuretic peptide (BNP). Methods: 102 new cases of heart failure were identified over 24 months in 213 patients referred to a rapid access heart failure clinic. Patients with heart failure and preserved systolic function with contemporary markers of diastolic function were assessed to evaluate their cardiac status further. Results: Forty patients (39%) had an ejection fraction (EF) < 45% and 62 (61%) had an EF ⩾ 45%. Of these 62 patients, 30 (48%) fulfilled the case definition of diastolic heart failure. The remaining 32 (52%) had neither an EF < 45% nor abnormalities of diastolic function. Dobutamine stress echocardiography was performed on 26 (42%) patients with EF ⩾ 45%, which provided an alternative explanation for symptoms in 15 (58%) patients. Concentrations of BNP were higher in patients with diastolic abnormalities (mean (SEM) 101.4 (32.5) pg/ml v 58.4 (6.78) pg/ml, p  =  0.042) and with no diastolic abnormalities (199 (37.9) pg/ml v 58.4 (6.78) pg/ml, p < 0.0001) than in patients with no heart failure. Conclusion: Among ambulatory patients presenting with suspected heart failure in the community 19% have systolic dysfunction, 14% have diastolic dysfunction, and 15% seemingly have heart failure with neither systolic nor diastolic dysfunction. A new understanding, including alternative parameters of diastolic function, seems to be necessary to classify patients with heart failure and preserved systolic function.