Do patients with suspected heart failure and preserved left ventricular systolic function suffer from "diastolic heart failure" or from misdiagnosis? A prospective descriptive study

BMJ. 2000 Jul 22;321(7255):215-8. doi: 10.1136/bmj.321.7255.215.


Objectives: To characterise the clinical features of patients with suspected heart failure but preserved left ventricular systolic function to determine if they have other potential causes for their symptoms rather than being diagnosed with "diastolic heart failure."

Design: Prospective descriptive study.

Setting: Outpatient based direct access echocardiography service.

Participants: 159 consecutive patients with suspected heart failure referred by general practitioners.

Main outcome measures: Symptoms (including shortness of breath, ankle oedema, and paroxysmal nocturnal dyspnoea) and history of coronary heart disease and chronic pulmonary disease. Transthoracic echocardiography, body mass index, pulmonary function tests, and electrocardiography.

Results: 109 of 159 participants had suspected heart failure in the absence of left ventricular systolic dysfunction, valvular heart disease, or atrial fibrillation. Of these 109, 40 were either obese or very obese, 54 had a reduction in forced expiratory volume in 1 second to </=70%, and 97 had a peak expiratory flow rate </=70% of normal. Thirty one patients had a history of angina, 12 had had a myocardial infarction, and seven had undergone a coronary artery bypass graft. Only seven patients lacked a recognised explanation for their symptoms.

Conclusions: For most patients with a diagnosis of heart failure but preserved left ventricular systolic function there is an alternative explanation for their symptoms-for example, obesity, lung disease, and myocardial ischaemia-and the diagnosis of diastolic heart failure is rarely needed. These alternative diagnoses should be rigorously sought and managed accordingly.

MeSH terms

  • Angina Pectoris / physiopathology
  • Body Mass Index
  • Cardiac Output, Low / diagnosis*
  • Cardiac Output, Low / physiopathology*
  • Diagnosis, Differential
  • Diagnostic Errors
  • Dyspnea / etiology
  • Dyspnea / physiopathology
  • Edema / etiology
  • Electrocardiography / methods
  • Female
  • Forced Expiratory Volume / physiology
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / physiopathology
  • Obesity / physiopathology
  • Prospective Studies
  • Respiration Disorders / diagnosis
  • Respiration Disorders / physiopathology
  • Ventricular Function, Left / physiology*