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 heart failure with preserved ejection fraction at this time, as the patient does not exhibit symptoms or signs of heart failure 1.

Echocardiogram Findings

The left ventricle has a 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 also normal with an E/A ratio of 1.2 and normal deceleration time of 209 ms. The left atrium is normal in size with a trace indexed volume of 8.3 ml/m². The right ventricle shows 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 a trace indexed volume of 10.6 ml/m².

Clinical Implications

According to the ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult, physicians should control systolic and diastolic hypertension, in accordance with published guidelines, to minimize symptoms of heart failure 1. However, in this case, the patient's echocardiogram does not indicate any abnormalities that would require treatment for heart failure with preserved ejection fraction.

Management

In the absence of symptoms or signs of heart failure, the management of this patient should focus on controlling any comorbid conditions, such as hypertension, and monitoring for any changes in cardiac structure or function. The use of beta-adrenergic blocking agents, angiotensin converting enzyme inhibitors, angiotensin II receptor blockers, or calcium antagonists may be considered in patients with controlled hypertension to minimize symptoms of heart failure, but this is not recommended in this case due to the lack of symptoms or signs of heart failure 1.

Quality of Life

The patient's quality of life is not expected to be impacted by the current cardiac structure and function, as the echocardiogram shows no abnormalities. However, regular follow-up appointments with a cardiologist are recommended to monitor for any changes in cardiac function and to address any concerns or symptoms that may arise.

From the Research

Echocardiogram Results

The provided echocardiogram results indicate:

• Normal left ventricular chamber size with an LVIDd of 5.3 cm
• Normal left ventricular hypertrophy (LVH) with an IVSd of 0.6 cm and LVPWd of 0.7 cm
• Normal global systolic function with an EF of 55-60% (visual) and 54% (Simpson's)
• Normal regional systolic function with an E/A ratio of 1.2 and DT of 209 ms
• Normal diastolic function with an E septal of 13.2 cm/s, E lateral of 18.8 cm/s, E/E medial of 9.2, and E/E lateral of 6.5
• Normal left atrial size with a trace indexed volume of 8.3 ml/m²
• Normal right ventricular wall thickness and chamber size with an RVID mid of 2.5 cm
• Normal right ventricular systolic function with a TAPSE of 2.6 cm
• Normal right atrial size with a trace indexed volume of 10.6 ml/m²

Relevant Studies

• A study published in 2019 2 discussed the safety and tolerability of statin therapy, highlighting its effectiveness in reducing the risk of myocardial infarction, ischemic stroke, and other complications of atherosclerotic disease.
• A 2023 study 3 explored the use of aspirin in conjunction with various statins for cardiovascular disease prevention, finding that aspirin combined with rosuvastatin was more effective in preventing individual cardiovascular disease events.
• A 2022 study 4 analyzed left atrial function in patients with sinus rhythm, normal left ventricular function, and indeterminate diastolic function, suggesting that left atrial function analysis may help in re-classifying patients with indeterminate diastolic function.
• A 2006 cost-utility analysis 5 compared the effects of aspirin therapy, statin therapy, combination therapy, and no pharmacotherapy for the primary prevention of coronary heart disease events in men, finding that aspirin was more effective and less costly than no treatment for men with a 10-year risk for CHD of 7.5% or higher.
• A 2022 review 6 discussed the pros of statin therapy for the primary prevention of cardiovascular disease, highlighting its efficacy, effectiveness, and safety, as well as its potential to exert pleiotropic effects that promote atherosclerotic plaque stability.

Key Findings

• The echocardiogram results indicate normal cardiac function and structure.
• Statin therapy is effective in reducing the risk of cardiovascular disease events, with aspirin combined with rosuvastatin being a potentially effective combination.
• Left atrial function analysis may be useful in evaluating patients with indeterminate diastolic function.
• Aspirin therapy is more effective and less costly than no treatment for primary prevention of coronary heart disease events in men with a 10-year risk for CHD of 7.5% or higher.
• Statin therapy has a range of benefits for primary prevention of cardiovascular disease, including its ability to exert pleiotropic effects that promote atherosclerotic plaque stability.