Evaluation of longitudinal systolic function in heart failure with normal ejection fraction.

Background: Heart failure with normal ejection fraction (HFNEF) is now the most prevailing model of HF in different epidemiological studies, and abnormalities in mild systolic function (subclinical) have been observed in those patients when the left ventricular contractility (LV) is evaluated in the longitudinal axis (S') by tissue Doppler echocardiography (TDE), even in normal LV ejection fraction.

Objective: To evaluate whether patients with HFNEF, according to the new criteria set out by the European Society of Cardiology, present changes in systolic function detected by S' measurement when compared with patients whose HFNEF has not been confirmed.

Methods: One hundred eighteen patients with signs or symptoms of HF underwent BNP measurement and TDE with measurements of longitudinal axis velocity during systole (S') and diastole (E') and measures of transmitral flow during diastole (E, A).

Results: HFNEF was confirmed in 38 patients (32.2%). Peak myocardial velocity during systole (S') and myocardial velocity in early diastole (E') were significantly reduced in patients with HFNEF compared to patients whose HFNEF was deleted (7.8 +/- 2.3 cm/s vs 9.4 +/- 2.5 cm/s p=0.002 - 7.7 +/- 2.6 cm/s vs 9.4 +/- 2.5 cm/s - p=0.001). Mean BNP values were higher in patients with HFNEF (140.5 +/- 122.4 pg/ml vs 23.1 +/- 25.0 pg/ml p <0.0001). S' correlated significantly with E' (r=0.457 - p<0.0001) revealing a strong link between ventricular contraction and relaxation.

Conclusion: Our findings show a reduction of systolic function, as measured by S 'in HFNEF and a linear correlation between the systolic (E / E 'and E') and diastolic dysfunction degree.