Role of Echocardiography in the Diagnosis of Patients with Diastolic Heart Failure

Diastolic heart failure (DHF) is characterized by heart failure signs and symptoms in the presence of normal ejection fraction (EF). Since it is still debatable whether or not systolic properties are normal, the term "heart failure with normal EF" has been used to describe this syndrome.1 The diagnosis of DHF is based on the presence of three findings: clinical heart failure, normal or only mildly reduced EF, and diastolic dysfunction. Once the clinical criteria are met (pulmonary/systemic congestion), imaging can be used to satisfy the other two diagnostic components. Given its versatility, good reproducibility, and high feasibility, echocardiography is often the only modality needed to establish the diagnosis and guide therapeutic decisions.

Investigators and clinicians can use echocardiography to reliably measure left ventricular (LV) volumes, mass, and EF.2 An EF of :a:50% is the cutoff recommended to identify DHF. The European guidelines¹ also mandate the presence of a LV end diastolic volume index s.97 ml/m² and an end systolic volume index s.49 ml/m². The vast majority of DHF patients have concentric remodeling or hypertrophy and, rarely, eccentric LV hypertrophy. However, it should be noted that the presence of hypertrophy is not mandatory to establish the diagnosis.