Congestive heart failure from left ventricular diastolic dysfunction in systemic hypertension

Am J Cardiol. 1993 Feb 1;71(4):308-12. doi: 10.1016/0002-9149(93)90796-f.

Abstract

Previous studies have pointed out that congestive heart failure (CHF) with normal ejection fraction presents a uniform clinical profile that is indistinguishable from heart failure with low ejection fraction. Thirty-six patients with systemic hypertension who had recently experienced CHF with normal ejection fraction (> or = 50%) and no clinical history of ischemic cardiomyopathy were studied. The patients were divided into 2 groups according to degree of echocardiographic hypertrophy: group A (19 patients) with a ventricular mass/volume ratio > 1.8, and group B (17 patients) with a ratio < 1.8. Group A patients had a higher ejection fraction (67 +/- 6 vs 57 +/- 3%, p < 0.01), smaller ventricular diameters and a lower thallium-201 positive rate at peak stress (10 vs 70% in group B, p < 0.001), with 8 of 10 showing severe coronary stenosis. Clinically, group A had a more frequent audible fourth sound (79 vs 17%, p < 0.001), a low incidence of audible third sound (5 vs 55%, p < 0.001) and a cardiothoracic ratio < or = 0.5 (63 vs 17%, p < 0.01). The degree of radionuclide-detected resting diastolic dysfunction and exercise intolerance was similar in both groups. In conclusion, CHF with normal ejection fraction in hypertensive patients presents 2 different profiles: one characterized by severe hypertrophy and the other by a high rate of myocardial regional ischemia. Therapy should be aimed at pathophysiologic regression of the hypertrophy in the first case, and at improvement of the ischemia in the second.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Analysis of Variance
  • Coronary Angiography
  • Diastole
  • Echocardiography / instrumentation
  • Echocardiography / methods
  • Exercise Test
  • Female
  • Gated Blood-Pool Imaging
  • Heart Failure / diagnosis
  • Heart Failure / epidemiology
  • Heart Failure / etiology*
  • Heart Failure / physiopathology
  • Humans
  • Hypertension / complications*
  • Hypertension / diagnosis
  • Hypertension / epidemiology
  • Hypertension / physiopathology
  • Hypertrophy, Left Ventricular / complications
  • Hypertrophy, Left Ventricular / diagnosis
  • Hypertrophy, Left Ventricular / epidemiology
  • Hypertrophy, Left Ventricular / physiopathology
  • Male
  • Middle Aged
  • ROC Curve
  • Ventricular Function, Left*