title: How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology.
abstract: Diastolic heart failure (DHF) currently accounts for more than 50% of all heart failure patients. DHF is also referred to as heart failure with normal left ventricular (LV) ejection fraction (HFNEF) to indicate that HFNEF could be a precursor of heart failure with reduced LVEF. Because of improved cardiac imaging and because of widespread clinical use of plasma levels of natriuretic peptides, diagnostic criteria for HFNEF needed to be updated. The diagnosis of HFNEF requires the following conditions to be satisfied: (i) signs or symptoms of heart failure; (ii) normal or mildly abnormal systolic LV function; (iii) evidence of diastolic LV dysfunction. Normal or mildly abnormal systolic LV function implies both an LVEF > 50% and an LV end-diastolic volume index (LVEDVI) <97 mL/m(2). Diagnostic evidence of diastolic LV dysfunction can be obtained invasively (LV end-diastolic pressure >16 mmHg or mean pulmonary capillary wedge pressure >12 mmHg) or non-invasively by tissue Doppler (TD) (E/E' > 15). If TD yields an E/E' ratio suggestive of diastolic LV dysfunction (15 > E/E' > 8), additional non-invasive investigations are required for diagnostic evidence of diastolic LV dysfunction. These can consist of blood flow Doppler of mitral valve or pulmonary veins, echo measures of LV mass index or left atrial volume index, electrocardiographic evidence of atrial fibrillation, or plasma levels of natriuretic peptides. If plasma levels of natriuretic peptides are elevated, diagnostic evidence of diastolic LV dysfunction also requires additional non-invasive investigations such as TD, blood flow Doppler of mitral valve or pulmonary veins, echo measures of LV mass index or left atrial volume index, or electrocardiographic evidence of atrial fibrillation. A similar strategy with focus on a high negative predictive value of successive investigations is proposed for the exclusion of HFNEF in patients with breathlessness and no signs of congestion. The updated strategies for the diagnosis and exclusion of HFNEF are useful not only for individual patient management but also for patient recruitment in future clinical trials exploring therapies for HFNEF.
authors.affiliation: Laboratory of Physiology, VU University Medical Center, Van der Boechorststraat, 7, 1081 BT, Amsterdam, The Netherlands. wj.paulus@vumc.nl
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Paulus
authors.forename: Carsten
authors.initials: C
authors.lastname: Tschöpe
authors.forename: John E
authors.initials: JE
authors.lastname: Sanderson
authors.forename: Cesare
authors.initials: C
authors.lastname: Rusconi
authors.forename: Frank A
authors.initials: FA
authors.lastname: Flachskampf
authors.forename: Frank E
authors.initials: FE
authors.lastname: Rademakers
authors.forename: Paolo
authors.initials: P
authors.lastname: Marino
authors.forename: Otto A
authors.initials: OA
authors.lastname: Smiseth
authors.forename: Gilles
authors.initials: G
authors.lastname: De Keulenaer
authors.forename: Adelino F
authors.initials: AF
authors.lastname: Leite-Moreira
authors.forename: Attila
authors.initials: A
authors.lastname: Borbély
authors.forename: István
authors.initials: I
authors.lastname: Edes
authors.forename: Martin Louis
authors.initials: ML
authors.lastname: Handoko
authors.forename: Stephane
authors.initials: S
authors.lastname: Heymans
authors.forename: Natalia
authors.initials: N
authors.lastname: Pezzali
authors.forename: Burkert
authors.initials: B
authors.lastname: Pieske
authors.forename: Kenneth
authors.initials: K
authors.lastname: Dickstein
authors.forename: Alan G
authors.initials: AG
authors.lastname: Fraser
authors.forename: Dirk L
authors.initials: DL
authors.lastname: Brutsaert
mesh_terms: D015415:Biomarkers / Q000097:blood; D032921:Consensus; D003937:Diagnosis, Differential; D003971:Diastole / Q000502:physiology; D015150:Echocardiography, Doppler / Q000379:methods*; D006333:Heart Failure / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D045265:Natriuretic Peptides / Q000097:blood*; D013318:Stroke Volume / Q000502:physiology
chemical_list: D015415:Biomarkers; D045265:Natriuretic Peptides