Heart Failure With Normal Ejection Fraction

A Growing Pandemic

Satnam Singh; Michael Frenneaux


Future Cardiol. 2012;8(3):383-392. 

In This Article

Definition of Heart Failure Normal Ejection Fraction

Heart failure (HF) comprises overlapping phenotypes affecting contractile and diastolic function to variable extents. Thus, while systolic HF is characterized by reduced left ventricular (LV) ejection fraction (LVEF), abnormal LV diastolic function is frequently present. HF with normal ejection fraction (HFNEF) is, by definition, associated with a normal LVEF and diastolic abnormalities appear to play a major role; nevertheless subtle abnormalities of systolic function insufficient to reduce LVEF are frequently present. Therefore, a simple and universal definition of HFNEF is lacking. LV contractile performance in general is assessed by LVEF, and various cutoffs have been used to define HFNEF ranging from 40 to 50%, the latter being selected in the European Society of Cardiology guidelines.[1] In addition, the European Society of Cardiology guidelines require clinical evidence of HF and evidence of moderate or severe LV diastolic impairment (using either Echo with or without BNP, or invasive measurements. Sustained arrhythmia and significant valvular disease should be excluded. LV hypertrophy (LVH) is usually present but the demonstration of LVH is not required in order to establish the diagnosis.


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