What is the diagnosis for a patient with a normal sinus rhythm, left ventricular (LV) ejection fraction (EF) of 55-60%, normal left ventricular hypertrophy (LVH), and normal systolic and diastolic function?

From the Guidelines

The patient's echocardiogram shows a normal sinus rhythm with normal cardiac structure and function, and therefore, no specific treatment is recommended for the heart failure with preserved ejection fraction (HFpEF) at this time, as the current evidence suggests that control of systolic and diastolic hypertension, in accordance with published guidelines, is the primary recommendation for patients with HFpEF 1. The left ventricle has normal size (LVIDd 5.3 cm), normal wall thickness (IVSd 0.6 cm, LVPWd 0.7 cm), and normal systolic function with an ejection fraction of 54-60%.

• Diastolic function is normal with an E/A ratio of 1.2 and deceleration time of 209 ms, which is consistent with the recommendations for the evaluation of left ventricular diastolic function by echocardiography 1.
• The left atrium is normal in size with an indexed volume of 8.3 ml/m².
• The right ventricle has normal wall thickness, chamber size (RVID mid 2.5 cm), and systolic function (TAPSE 2.6 cm).
• The right atrium is normal in size with an indexed volume of 10.6 ml/m². These findings indicate a structurally normal heart with preserved function and no evidence of chamber enlargement, hypertrophy, or dysfunction. According to the guidelines, physicians should control systolic and diastolic hypertension, in accordance with published guidelines, which is a Class I recommendation with Level A evidence 1. Additionally, the use of diuretics to control pulmonary congestion and peripheral edema is also a Class I recommendation with Level C evidence 1. However, the current evidence does not support the use of specific medications for HFpEF, and the primary focus should be on controlling hypertension and managing symptoms. It is essential to continue monitoring the patient's condition and adjusting the treatment plan as needed to ensure the best possible outcomes in terms of morbidity, mortality, and quality of life.

From the Research

Left Ventricle Analysis

• The left ventricle chamber size is normal with an LVIDd of 5.3 cm 2.
• The left ventricle hypertrophy (LVH) is normal with an IVSd of 0.6 cm and LVPWd of 0.7 cm.
• The systolic function is normal with a global ejection fraction (EF) of 55-60% and a mass index of 61 g/m².
• The diastolic function is normal with an E/A ratio of 1.2 and a deceleration time (DT) of 209 ms.

Left Atrium Analysis

• The left atrium size is normal with a trace indexed volume of 8.3 ml/m².

Right Ventricle Analysis

• The right ventricle wall thickness is normal.
• The right ventricle chamber size is normal with an RVID mid of 2.5 cm.
• The systolic function is normal with a tricuspid annular plane systolic excursion (TAPSE) of 2.6 cm.

Right Atrium Analysis

• The right atrium size is normal with a trace indexed volume of 10.6 ml/m².

Treatment Options

• According to the studies, ACE inhibitors and beta-blockers are recommended for the treatment of heart failure 2, 3, 4.
• The combination of a diuretic and an ACE inhibitor is currently the proper treatment of congestive heart failure, with a beta-blocker added in selected patients 3.
• The use of ARBs is less persuasive and should be prescribed only when an ACE inhibitor cannot be tolerated 3.
• The treatment of heart failure should be individualized based on the underlying pathophysiology and the patient's specific needs 5.