What are the next steps in monitoring or treatment for an elderly patient with a hyperdynamic ejection fraction (EF) greater than 65% on echocardiogram and mild valvular disease?

From the Guidelines

For an elderly patient with hyperdynamic EF >65% on echocardiogram and mild valvular disease, the primary focus should be on controlling systolic and diastolic hypertension, as well as managing any symptoms or conditions that may be contributing to the hyperdynamic state, as recommended by the ACC/AHA guidelines 1. The patient's hyperdynamic EF >65% indicates a preserved left ventricular ejection fraction, and the presence of mild valvular disease should be monitored regularly. According to the ACC/AHA guidelines, controlling systolic and diastolic hypertension is crucial, with a recommendation of Class I, Level of Evidence A 1. Key aspects of management include:

• Controlling systolic and diastolic hypertension in accordance with published guidelines, as this is a Class I, Level of Evidence A recommendation 1
• Using diuretics to control pulmonary congestion and peripheral edema if necessary, as this is a Class I, Level of Evidence C recommendation 1
• Considering the use of beta-adrenergic blocking agents, angiotensin converting enzyme inhibitors, angiotensin II receptor blockers, or calcium antagonists to minimize symptoms of heart failure, although this is a Class IIb, Level of Evidence C recommendation 1
• Regular cardiac monitoring every 6-12 months with repeat echocardiograms to track any progression of the valvular disease
• Addressing underlying conditions that may contribute to the hyperdynamic state, such as anemia, hyperthyroidism, or anxiety disorders
• Lifestyle modifications including moderate exercise, sodium restriction (<2g/day), and maintaining hydration are beneficial It is essential to note that the morbidity and mortality associated with heart failure and a relatively preserved LVEF may be nearly as profound as that with low LVEF, and frequent and repeated hospitalizations characterize the patient with heart failure and a normal LVEF 1.

From the Research

Monitoring and Treatment of Hyperdynamic EF

• For an elderly patient with a hyperdynamic EF >65% on echocardiogram and mild valvular disease, it is essential to consider the potential risks and complications associated with this condition 2.
• The patient's hyperdynamic heart may be indicative of underlying diastolic dysfunction, which can lead to heart failure with preserved ejection fraction (HFpEF) 3, 4.
• Echocardiography can play a crucial role in evaluating the patient's left ventricular hemodynamics and guiding treatment decisions 5.
• The presence of mild valvular disease may also impact the patient's prognosis and treatment options, and early intervention may be necessary to improve symptoms and prolong survival 3.

Echocardiographic Parameters

• Echocardiographic parameters such as lateral e' velocity, LA diameter, LA volume index, E velocity, TR jet velocity, and average E/e' ratio can help differentiate between asymptomatic left ventricular diastolic dysfunction and HFpEF 4.
• Reduced lateral e' velocity has been associated with symptomatic state in left ventricular diastolic dysfunction and may be a useful predictor of disease severity 4.

Prognosis and Outcomes

• Patients with hyperdynamic EF have been shown to have increased mortality rates compared to those with normal ejection fraction 2, 6.
• The presence of hyperdynamic EF may be a useful prognostic marker for identifying patients at high risk of adverse outcomes, and further research is needed to determine the optimal management strategies for these patients 6.