title: Progression of preserved systolic function heart failure to systolic dysfunction -- a natural history study.
abstract: OBJECTIVE
  To assess the natural history of left ventricular (LV) structure and function in sequential heart failure admissions with preserved systolic function.
  
  
  BACKGROUND
  Heart failure (HF) with preserved LV systolic function accounts for between 20% and 30% of typical HF populations. Few data are available concerning the natural history of structural and functional changes in the LV in this patient population.
  
  
  METHODS
  We consented sequential admissions from the community with confirmed heart failure to participate in this study. Doppler-echocardiography was used to assess Ejection Fraction (EF), LV structure, regional wall motion and parameters of diastolic function including E:A ratio, E-wave deceleration time (DtE) and isovolumic relaxation time (IVRT). Follow-up echocardiography was carried out at three months (mean 103+/-13 days) from discharge.
  
  
  RESULTS
  Of 210 sequential admissions with primary heart failure 56 had preserved systolic function (LVEF> or =45%). Follow-up data at three months were available in 38 patients (mean age 72 years) with preserved LV systolic function. Of the group, 9 had been admitted within three months of discharge, 5 for recurrent HF. Eight patients (21%) exhibited significant decline in LV systolic function at follow-up, all with LVEF<45%. Three exhibited regional wall-motion abnormalities with the remainder showing dilatation and global reduction in function. None of these eight had presented to hospital for any cause other than routine outpatient department (OPD) visits during the 3 months.
  
  
  CONCLUSIONS
  Patients with preserved systolic function HF, a significant number may progress to systolic dysfunction with or without clinical events.
authors.affiliation: St. Vincent's University Hospital, Heart Failure Unit, Elm Park, Dublin 4, Ireland.
authors.forename: John M
authors.initials: JM
authors.lastname: Cahill
authors.forename: Enda
authors.initials: E
authors.lastname: Ryan
authors.forename: Bronagh
authors.initials: B
authors.lastname: Travers
authors.forename: Mary
authors.initials: M
authors.lastname: Ryder
authors.forename: Mark
authors.initials: M
authors.lastname: Ledwidge
authors.forename: Ken
authors.initials: K
authors.lastname: McDonald
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D003971:Diastole / Q000502:physiology*; D018450:Disease Progression; D015150:Echocardiography, Doppler; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D015203:Reproducibility of Results; D013599:Systole / Q000502:physiology*; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology*