Clinical and Echo Profile in Heart Failure with preserved ejection fraction

An estimated half of all patients with HF have preserved ejection fraction. The risk factors, clinical features, pathophysiology and course of the illness have extensively been studied recently. In the present series 103 patients of heart failure fulfilling Framingham criteria who were admitted in General Medical Ward in Coimbatore Medical College Hospital, Coimbatore-18, during the period between September 2009 to September 2010 were studied. Most have demonstrated minimal difference between clinical symptoms, signs, radiographic findings and have documented that none of the clinical features can be used to distinguish patients with HFPEF reliably from those with HFrEF. Assessment of EF with cardiac imaging is needed to distinguish HFPEF with HFrEF. Present study can be seen as an assessment of the clinical course of HF with preserved EF as compared with that of HF with reduced EF from the same point in the evaluation of the disease. In the present study, 42% of HF patients had an EF≥50%. Women >65yrs of age were more affected. Subtle differences were observed on physical examination. AF did not show significance in HFPEF (9%) as well as in HFrEF (7%) whereas Theophilus E Owan et al. studies showed that it was significant in HFPEF(41%). SHT, CAD and DM were the most significant risk factors in both types of heart failure. Smoking and alcoholism were not significant in HFPEF, but significant in HFrEF, whereas Vasan et al. studies concluded that no significant difference between the two types of heart failure. Vasan et alstudies showed mean SBP was 143± 24 mmHg and DBP was 73± 13mmHg in HFPEF whereas present study showed mean SBP was148± 15mmHg and mean DBP was 90± 25mmHg in patients with HFPEF. Patients with HFrEF had mean SBP 120± 10mmHg, mean DBP 80± 15mHg. ECG evidence of IHD was 48% in patients with HFPEF, 90% in patients with HFrEF. Evidence of LAE was highly significant in both types of Heart Failure. AF, RBBB, and LBBB were not significant in both types of Heart Failure. Pulmonary venus hypertension (72%) was present in CXR of patients with HFPEF as compared to 87% in HFrEF. Cardiomegaly and pleural effusion were highly significant in HFrEF. In Echocardiogram mean LVEDD is 44± 6 mm in HFPEF and mean LVEDD is 56.5± 7 mm in HFrEF. Observed E/A ratio were reduced to below one in HFPEF(mean is 0.83). Micheal R Zile et al. studied patients with HFNEF with Echocardiography to assess the diastolic function by the following parameters mainly: 1. Left ventricular dimension. 2. Left ventricular wall thickness. 3. Transmitral flow velocities (E/A ratio). 4. Wall motion abnormalities. Patients in present study were also evaluated with the above parameters and cardiac catheterization was not performed as facilities were inadequate. CONCLUSION : 1. 103 Patients of Heart failure were analyzed. Among them 42% of patients had EF ≥ 50% and 58% patients had EF < 50%. 2. Mean age of patients in HFPEF was 57± 9 for males, 62.8 ± 12 for females. Mean age of patients in HFrEF was 52 ± 10 for males, 54 ± 10 for females. 3. Women with the age of 65 yrs and above (25%) were mostly affected with HFPEF. 4. Exertional Breathlessness was the most common presenting symptom (93%) in both types of HF. Rales in the lung fields was present in 100% of patients with HF. Elevated JVP was the 2nd most common sign in both types of HF. 5. Mean SBP and DBP was higher in patients with HFPEF than in patients with HFrEF. 6. SHT was the most common risk factor in HFPEF (48%). CAD was the most common risk factor (25%) in HFrEF. DM was significant in both types HF. Alcoholism and smoking were significant in HFrEF than in HFPEF. 7. LAE was the significant manifestation in ECG, 63% in HFPEF and 58% in HFrEF. Evidence of IHD was 90% in HFrEF and 48% in HFPEF. 3rd common manifestation was LVH (significant) in both types of HF. AF was 9% in HFPEF (not significant) and 7% in HFrEF (not significant). 8. Pulmonary venus hypertension was highly significant finding in both types of HF. Cardiomegaly and pleural effusion were significant in HFrEF than in HFPEF. 9. SHT was the most common risk factor in HFPEF whereas CAD in HFrEF. 10. DM was the significant risk factor in both types of HF. Alcoholism and smoking were significant in HFrEF than in HFPEF. 11. Observed E/A ratio were reduced to below one in HFPEF (Mean was 0.83). 12. About 10% of HF patients had no evidence of DD or SD. Those patients yet to be evaluated with cardiac catheterization and other advanced techniques