From the Guidelines
A symptomatic patient with normal ejection fraction and impaired relaxation filling pattern on echocardiogram should receive cardiology follow-up. This presentation suggests heart failure with preserved ejection fraction (HFpEF), which requires specialized management despite the normal pumping function. The impaired relaxation pattern indicates diastolic dysfunction, where the heart struggles to fill properly during relaxation. Symptoms like shortness of breath, fatigue, or exercise intolerance in this context warrant cardiologist evaluation to establish a diagnosis, determine severity, and develop a treatment plan. Management typically includes diuretics like furosemide 20-40mg daily for symptom relief, blood pressure control with ACE inhibitors or ARBs, and addressing underlying conditions such as hypertension or diabetes 1. The cardiologist may recommend additional testing like stress echocardiography or cardiac MRI to further characterize the condition. Early intervention is important as diastolic dysfunction can progress and lead to worsening heart failure symptoms even with preserved ejection fraction.
Key Considerations
- Diastolic dysfunction is a key component of HFpEF, and its diagnosis is based on echocardiographic parameters such as mitral inflow pattern, tissue velocities, and E/e' ratio 1.
- The 2016 ESC guidelines and 2016 ASE/EACVI recommendations provide a framework for the diagnosis and evaluation of diastolic function in patients with HFpEF 1.
- Cardiology follow-up is essential to monitor disease progression, adjust treatment, and improve quality of life.
Treatment and Management
- Diuretics, such as furosemide, are commonly used to relieve symptoms of volume overload 1.
- ACE inhibitors or ARBs are used to control blood pressure and reduce left ventricular mass index 1.
- Addressing underlying conditions, such as hypertension or diabetes, is crucial to slow disease progression and improve outcomes 1.
From the Research
Diastolic Dysfunction and Cardiology Follow-up
- A patient with a normal ejection fraction and impaired relaxation filling pattern on echocardiogram (echo) is indicative of diastolic dysfunction, as stated in 2, 3.
- Diastolic dysfunction can be a cause of symptoms in patients with heart failure, even in the presence of a normal ejection fraction, as noted in 4, 5.
- The diagnosis of diastolic dysfunction is crucial, as it can guide treatment and management of the patient's symptoms, as discussed in 3, 6.
- Echocardiography is a useful tool in the diagnosis of diastolic dysfunction, as it allows for the non-invasive evaluation of mitral and pulmonary venous flow, as mentioned in 3, 5.
- Patients with impaired relaxation filling pattern and preserved left ventricular ejection fraction can have a wide spectrum of left ventricular systolic and diastolic performance abnormalities, as found in 5.
- Given the patient's symptomatic status, cardiology follow-up is necessary to monitor and manage their condition, as diastolic dysfunction can be a precursor to heart failure, particularly heart failure with preserved ejection fraction, as discussed in 4, 6.
Management and Treatment
- Treatment of diastolic dysfunction should focus on controlling symptoms and addressing the underlying cause, as stated in 3.
- Calcium channel blockers, ACE inhibitors, or beta-blockers may be used as first-line treatments for diastolic dysfunction, as mentioned in 2, 3.
- Diuretics can be added to manage increasing symptoms, but digitalis should be avoided except in cases of atrial fibrillation, as noted in 2.
- Relief of myocardial ischemia, control of arterial hypertension, and regression of ventricular hypertrophy are important objectives of treatment, as discussed in 3, 6.