Role of Echocardiography in the Diagnosis of Heart Failure with Preserved Left Ventricular Systolic Function: Update 201

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ECHOCARDIOGRAPHY (T BUCK, SECTION EDITOR)

Role of Echocardiography in the Diagnosis of Heart Failure with Preserved Left Ventricular Systolic Function: Update 2013 Mohammad Kavianipour & Amir Farkhooy & Frank A. Flachskampf

Published online: 14 August 2013 # Springer Science+Business Media New York 2013

Abstract Heart failure and its complications are significant causes of mortality and morbidity in most societies. Major parts of the studies that constitute the base of modern treatment of heart failure have been limited to the study of heart failure associated with reduced left ventricular ejection fraction (HFrEF). Only during the past 10–15 years, heart failure associated with preserved left ventricular ejection fraction (HFpEF) or primarily right-sided heart failure have come more into focus as our understanding of the critical role of other etiologies for the clinical syndrome of heart failure than a reduced left ventricular (LV) ejection fraction has increased. Furthermore, whilst the powerful prognostic role of a reduced LV ejection fraction has long since been well validated, only relatively recently it was realized that patients with heart failure symptoms and preserved LVejection fraction also have a substantially impaired prognosis. Previously, these patients had often been dismissed as not having "real heart failure". In parallel, it has become clear that diagnoses like hypertensive heart disease, diabetic cardiomyopathy and heart failure associated with atrial fibrillation, among others, can be understood as forms of HFpEF. Keywords Heart failure with preserved ejection fraction . Diastolic function . Echocardiography . Stress testing

M. Kavianipour : F. A. Flachskampf Department of Medical Sciences: Cardiology, Uppsala University, 751 85 Uppsala, Sweden A. Farkhooy : F. A. Flachskampf Department of Medical Sciences: Clinical Physiology, Uppsala University, Uppsala, Sweden F. A. Flachskampf (*) Dept of Cardiology, Uppsala University Hospital, 751 85 Uppsala, Sweden e-mail: [email protected]

Introduction In the past, the term ”diastolic heart failure” was often used to describe HFpEF as it was thought that isolated impairment of LV diastolic function was the sole pathogenesis of the disease. However, the term diastolic heart failure was abandoned in favour of HFpEF as it stood clear that diastolic impairment was also prevalent in HFrEF, and, vice versa, that a variety of systolic LV abnormalities exist in HFpEF patients. These systolic abnormalities include reduced LV longitudinal function (detectable by M-mode of mitral annular motion, tissue Doppler, or deformation imaging by speckle tracking), and reduced ventricular systolic rotation [1–3]. Also, HFpEF patients often may have low normal or mildly impaired ejection fraction, with symptoms and signs of heart failure that cannot be explained on the basis of such minor reduction in ejection fraction. Therefore, the term "preserved" rather than "normal" has been adopted in the naming of HFpEF. HFpEF is frequent. In an analysis of 4596 pati

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