Early recognition of diastolic dysfunction in primary care setting

Abstract

Introduction: Diastolic dysfunction, often not accompanied by recognized symptoms of congestive heart failure, is known to be associated with marked increase in all cause mortality. Isolated clinical symptoms of dyspnea on exertion (DOE) and peripheral edema (PE) described as minor Framingham criteria and not considered to be validated for the clinical diagnosis of CHF represent significant proportion of patients referred for echocardiography examination in our institution by primary care physicians. Considerable percentage of those patients have normal ejection fraction. Study hypothesis: using Doppler tissue imaging (TDI) of mitral annulus velocities combined with pulsed wave (PW) Doppler examination of mitral inflow and pulmonary vein (PV) flow may provide additional diagnostic information in patients with isolated symptoms of heart failure and normal systolic function. Methods: total of thirty-one patients were referred to our Echocardiography Laboratory by primary care physicians for evaluation of DOE or/and PE; twenty-seven of them had normal ejection fraction >50%. All patients underwent the standardized protocol including PW examination of mitral inflow, PV flow and TDI. Group of thirty-eight asymptomatic patients with normal ejection fraction was used as a control group. Ratio of E (mitral early inflow peak velocity) to Ea (TDI early diastolic velocity) was calculated in all patients according to the protocol. Results: E to Ea ratio in the group of symptomatic patients with normal ejection fraction was noted to be significantly elevated (11.5±5.9 cm/s) as compare to control group (8.4±2.5 cm/s, P = 0.024). Conclusion: using TDI indices in patients with isolated symptoms of heart failure may be a powerful tool for early recognition of diastolic dysfunction. Awareness of the presence of diastolic heart failure by primary care physicians is an important step in prevention of CHF.