Heart failure with normal ejection fraction: not to be underestimated

In recent years, after in-depth study of heart failure, it has been found that a large number of patients with heart failure can still maintain a relatively normal left ventricular ejection fraction (LVEF). In the past, such heart failure was called systolic or diastolic heart failure. In 2007, the heart failure and cardiac ultrasound group of the European Heart Society (ESC) renamed this kind of heart failure as heart failure with normal left ventricular ejection fraction (HFNEF), and published the expert consensus on the diagnosis of this disease in the European Heart J 2007, 28 (20): 2539. At present, most doctors' cognition of HFNEF is far less than that of systolic insufficiency (decreased ejection fraction) heart failure. There are still many outstanding problems to be explored in the pathogenesis and diagnosis and treatment of HFNEF.

1. Concept of HFNEF

HFNEF often refers to diastolic heart failure (DHF), which is caused by diastolic dysfunction caused by slow left ventricular relaxation and left ventricular stiffness. However, HFNEF is not completely equivalent to DHF. It can also be seen in systolic heart failure (SHF). Although patients with HFNEF retain the overall left ventricular systolic function, there is still a decrease in myocardial Doppler velocity, which indicates that the systolic function is damaged to some extent. In the absence of accurate distinction between left ventricular diastolic and systolic dysfunction, it is suggested that heart failure without decreased LVEF should be called HFNEF or heart failure with left ventricular ejection function in clinical diagnosis and clinical research, rather than DHF.

2. HFNEF diagnosis: expert consensus

LVEF ≥ 50% in more than half of patients with heart failure;, HFNEF was manifested, and most of them were elderly, female and hypertensive patients. HFNEF is similar to SHF, with high incidence rate and mortality rate (1 years mortality rate is >). 20%), And the prevalence is rising.

the diagnosis of HFNEF is complex. In 2007, ESC experts agreed to update the diagnostic criteria of the disease (Figure 1). The core is to meet three conditions: symptoms or signs of heart failure: only dyspnea can also be used as clinical evidence of HFNEF. Normal or slightly abnormal left ventricular systolic function: LVEF & gt; 50%, Left ventricular end diastolic volume index (LVEDVI)