Clinical and echocardiographic study of patients in heart failure with a normal/near normal ejection fraction

Abstract

Background: Heart failure affects more than twenty million people worldwide. Epidemiological studies have shown that approximately one-half of the patients who develop heart failure have a normal or near normal ejection fraction. The diagnosis of heart failure with a normal ejection fraction (HFNEF) is difficult as compared to those with reduced ejection fraction, and so is the treatment. It is caused by diastolic ventricular dysfunction demonstrated by complementary methods. It affects primarily the elderly individuals with co-morbidities such as hypertension, diabetes, obesity, renal dysfunction, atrial fibrillation etc. The aim of this research was to study the clinical and echocardiographic profile of patients in heart failure with a normal/near normal ejection fraction. Methods: This was a prospective, open-labeled, observational study conducted on 70 subjects. All patients with suspected heart failure, fulfilling the Framingham criteria were included in the study. Patients with a reduced ejection fraction ( 1.2 mg%. Mean creatinine was 1.35 ± 0.65 mg%. 63% patients in the study group were anemic with a mean hemoglobin level of 11.3 ± 2.27 g%. 57% of the cases had HbA1c ≥ 5.7% of which, 28% had HbA1c in the pre-diabetic range. 16 patients (22.85%) had a history of atrial fibrillation. 22.8% patients had left ventricular diastolic dysfunction (LVDD) grade 1, 54.3% patients had LVDD grade 2, 20% has LVDD grade 3 and 2.85% had LVDD grad 4. 16 cases had a prolonged deceleration time (DT), with a mean DT of 225 ms. In cases of mild diastolic dysfunction due to impaired relaxation, IVRT was prolonged. Mean IVRT values in the LVDD grade 1 was 119 ms. The echocardiographic indices of restrictive cardiomyopathy showed an E/A ratio of >2.4 (mean 2.76) and E/e’ >15 (mean 17.51). IVRT was markedly reduced in patients with restrictive cardiomyopathy (mean IVRT was 51.09 ms). Conclusion: In the current study, we have seen that heart failure with normal or near normal ejection fraction is more common in females and in the elderly. Hypertension, diabetes mellitus, renal dysfunction, thyroid disorders and atrial fibrillation are associated commonly with HFNEF. Abnormal relaxation, pseudonormal filling pattern and restrictive filling are the mechanisms responsible for diastolic dysfunction.