2009 Southern Regional Meeting Abstracts

Purpose of Study: To evaluate the left ventricular (LV) diastolic chamber size in patients with heart failure and normal ejection fraction (HFNEF).
Methods Used: We reviewed the coded database of echocardiographic studies performed at one institution between July of 2007 and June of 2008. We performed a retrospective descriptive study of 35 patients who had a normal ejection fraction (>55%) and elevated left-sided filling pressures at the time of the echocardiogram, according to the echocardiographic parameters of advanced diastolic dysfunction. We looked at their left ventricular internal diastolic diameter (LVIDD).
Summary of Results: Our population had a high prevalence of hypertension (100%), obesity (63%), diabetes (40%), chronic kidney disease stages 3 to 5 (51%), coronary artery disease (25%), and anemia (43%). The left atrial antero-posterior diameter was increased (>3.9 cm) in 86% of the patients, and left ventricular hypertrophy (defined as interventricular septal thickness >11 mm) was identified in 65% of the patients. Only 14% of the patients had an increased left ventricular internal diastolic diameter above the absolute upper limits of normal (>5.9 cm for males, >5.3 cm for females). However, the distribution of left ventricular end-diastolic diameter values was mildly skewed to higher values in comparison to a normal historical population: 4.85 +/- 0.5 cm for females, 5.3 +/- 0.5 cm for males, as compared to 4.6 +/- 0.3 cm for normal females (p 0.045) and 5 +/- 0.4 cm for normal males (p<0.001).The distribution of indexed LVIDD was, however, comparable to that of a normal historical population: 2.6 +/- 0.4 cm/m2, as compared to 2.7 +/- 0.2 cm/m2 for the normal population (p NS)
Conclusions: In a population of patients with a normal ejection fraction, high left ventricular filling pressures, and a high prevalence of comorbid conditions, LV diastolic size is only mildly increased in comparison to a normal population and is rarely increased above the absolute upper limit of normal. This confirms the concept that HFNEF is related to an abnormal diastolic left ventricular pressure-volume relationship, with no or with mild ventricular volume overload.