What is suspected heart failure with preserved left ventricular systolic function?

doi:10.1136/bmj.322.7280.238

BMJ 2001;322:238 ( 27 January )

Letters

What is suspected heart failure with preserved left ventricular systolic function?

Clinical suspicion of diastolic heart failure should rely on more than symptoms of dyspnoea

Paper does not provide evidence that diastolic dysfunction is a misdiagnosis

Measurement of E:A ratio is both insensitive and non-specific

Author's reply

Clinical suspicion of diastolic heart failure should rely on more than symptoms of dyspnoea

The first 150 words of the full text of this article appear below.

EDITOR $---$ Caruana et al's study focuses on the well established difficulties in the diagnosis of diastolic heart failure in thecommunity.¹ I question the authors' conclusions that most patientsin the community with a diagnosis of diastolic heart failure haveunrelatedconditions.

Proposed criteria for the diagnosis of diastolic heart failure require definitive evidence of congestive heart failure byclinical criteria, physical examination, chest radiography, responseto diuretics, etc as a starting point. ² ³ The authors donot provide the indications that led the primary physicians torefer the patients for echocardiography; the clinical suspicionof diastolic heart failure should rely on more than symptoms ofdyspnoea at rest or on exertion, for which the differential diagnosisisbroad.

The authors consider a history of coronary artery disease or electrocardiographic changes consistent with coronary diseaseto be an alternative explanation for the patients' symptoms. Inpatients with normal systolic function . . . [Full text of this article]