Do patients with suspected heart failure and preserved left ventricular systolic function suffer from "diastolic heart failure" or from misdiagnosis? A prospective descriptive study

doi:10.1136/bmj.321.7255.215

BMJ 2000;321:215-218 ( 22 July )

General Practice

Do patients with suspected heart failure and preserved left ventricular systolic function suffer from "diastolic heart failure" or from misdiagnosis? A prospective descriptive study

Editorial by Hobbs

Lynn Caruana, senior cardiac technician, Mark C Petrie, specialist registrar in cardiology, Andrew P Davie, specialist registrar in cardiology, John J V McMurray, professor of medical cardiology.

Department of Cardiology, Western Infirmary, Glasgow G11 6NT

Correspondence to: J McMurray j.mcmurray{at}bio.gla.ac.uk

Objectives: To characterise the clinical features of patientswith suspected heart failure but preserved left ventricular systolicfunction to determine if they have other potential causes fortheir symptoms rather than being diagnosed with "diastolic heartfailure."
Design: Prospective descriptivestudy.
Setting: Outpatient based direct access echocardiographyservice.
Participants: 159 consecutive patients with suspected heartfailure referred by generalpractitioners.
Main outcome measures: Symptoms (including shortness of breath, ankleoedema, and paroxysmal nocturnal dyspnoea) and history of coronaryheart disease and chronic pulmonary disease. Transthoracic echocardiography,body mass index, pulmonary function tests, andelectrocardiography.
Results: 109 of 159 participants had suspected heartfailure in the absence of left ventricular systolic dysfunction,valvular heart disease, or atrial fibrillation. Of these 109,40 were either obese or very obese, 54 had a reduction in forcedexpiratory volume in 1 second to $=<$ 70%, and 97 had a peak expiratoryflow rate $=<$ 70% of normal. Thirty one patients had a history ofangina, 12 had had a myocardial infarction, and seven had undergonea coronary artery bypass graft. Only seven patients lacked a recognisedexplanation for theirsymptoms.
Conclusions: For most patients with a diagnosis of heartfailure but preserved left ventricular systolic function thereis an alternative explanation for their symptoms $---$ for example,obesity, lung disease, and myocardial ischaemia $---$ and the diagnosisof diastolic heart failure is rarely needed. These alternativediagnoses should be rigorously sought and managedaccordingly.

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