From the Guidelines
I would explain to the patient that they have a mild form of heart dysfunction called grade 1 diastolic dysfunction, but their heart's pumping ability remains normal with an ejection fraction of 55%. This means that while their heart is effectively pushing blood out to the body (normal is typically 50-70%), there is some stiffness in the heart muscle that makes it slightly harder for the heart to relax and fill with blood between beats. According to the 2022 AHA/ACC/HFSA guideline for the management of heart failure 1, patients with an ejection fraction of 55% would be classified as having heart failure with preserved ejection fraction (HFpEF) if they have symptoms of heart failure, but in this case, the focus is on the diastolic dysfunction. This early stage condition often causes no symptoms and may be discovered during routine testing.
It's essential to address risk factors like high blood pressure, diabetes, or being overweight to prevent progression. I would recommend lifestyle modifications including:
- Regular exercise (aim for 150 minutes of moderate activity weekly)
- Maintaining a heart-healthy diet low in sodium and saturated fats
- Weight management if needed
- Strict control of blood pressure and blood sugar Medications are typically not required at this early stage unless there are other cardiac conditions present. Regular follow-up appointments every 6-12 months would be important to monitor for any changes in heart function, as there is limited evidence to guide therapy for patients who improve their LVEF from mildly reduced to ≥50% 1. This condition is very manageable, especially when caught early, and many people with grade 1 diastolic dysfunction maintain good quality of life with proper care.
From the Research
Describing Diastolic Dysfunction to a Patient
- A patient with grade 1 diastolic dysfunction and an ejection fraction of 55% has a condition where the heart's ability to relax and fill with blood between beats is impaired, but the heart's pumping function is still relatively preserved 2.
- This condition is often referred to as heart failure with preserved ejection fraction (HFpEF), where the left ventricular ejection fraction is greater than 50% 2.
- The patient's ejection fraction of 55% indicates that the heart is still pumping blood effectively, but the diastolic dysfunction may cause symptoms such as shortness of breath, fatigue, or swelling in the legs and feet 3.
- It is essential to explain to the patient that diastolic dysfunction can be a precursor to more severe heart failure and that managing associated conditions, such as hypertension, is crucial to prevent further deterioration 2, 4.
Management and Treatment
- The treatment of diastolic dysfunction and HFpEF often focuses on managing associated conditions, such as hypertension, rather than the underlying pathophysiology 2.
- Angiotensin-converting enzyme (ACE) inhibitors may be prescribed to improve outcomes in patients with heart failure and preserved ejection fraction, as they have been shown to reduce the risk of all-cause mortality or heart failure hospitalization 4.
- Guideline-directed medical therapy (GDMT) is the cornerstone of pharmacological therapy for patients with heart failure, but its application in patients with preserved ejection fraction is still being studied 5.
Monitoring and Follow-up
- Regular echocardiographic monitoring is essential to assess the progression of diastolic dysfunction and the development of left ventricular dysfunction 6.
- A thorough clinical evaluation, along with natriuretic peptides and cardiac catheterization in selected cases, is necessary to diagnose and manage diastolic dysfunction and HFpEF 3.