Early diagnosis HFpEF, heart failure with preserved ejection fraction in cardiomyopathy, a chance to treat and reduce morbidity and mortality

Vijayashree S. Gokhale, Atiulla I. Malik, Atiulla I. Malik, Ponvijaya M. Yadav, Ponvijaya M. Yadav, Kunal Garg, Kunal Garg


Background: Cardiomyopathy as a diagnosis almost signifies a kind of end stage disease of the myocardium. With conditions like hypertension, diabetes and ischemic heart disease on the rise, we are seeing a large number of cases diagnosed as cardiomyopathy, most common presenting feature being Heart failure. Echocardiography (ECG), is non-invasive and easily available and can pick up early signs of failure in the form of diastolic and systolic dysfunction. To study patients with cardiac symptoms, by clinical, ECG, and Echocardiography parameters.

Methods: A cross-sectional, observational study of 50 patients aged 18-80 years with cardiac symptoms (dyspnoea, palpitations, pedal odema) was carried out over a period of 3 years in a semi-urban Medical College Hospital in Western Maharashtra. Patients of Acute coronary disease, valvular and congenital heart disease and chronic obstructive pulmonary disease (COPD) were excluded from the study. Data collected, tabulated and subjected to statistical analysis.

Results: Our study of 50 patients had 50% Diabetic and 42% Hypertensive patients. 2D echo findings were clinically significant in the form of diastolic dysfunction (36%), systolic dysfunction (12%). Ejection fraction (EF) was significantly reduced, in most patients, but 4% patients had HFpEF, i.e. EF=55% and 24% had EF between 30-55%

Conclusions: Our study of 50 patients of Cardiomyopathy had more hypertensives and diabetics, and most of them less than 60 years of age and mostly male. HFpEF was detected in 4% and 76% had EF30-60% and 24% had EF<30%. Diastolic dysfunction was diagnosed in more than half and systolic dysfunction in few on ECG.




Cardiomyopathy, Heart failure, Ejection fraction, Diastolic dysfunction

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Wynne J, Eugene, Braunwald E. Cardiomyopathy and Myocarditis. Harrisons principles of internal medicine, 20th edition. 2:1481-88.

Braunwald E. Cardiomyopathies an overview. Circ Res. 2017;121:711-21.

Davies M. The cardiomyopathies: an overview Heart. 2000;83(4):469-74.

Pinto YM, Elliott PM, Arbustini E, AdlerY, Anastasakis A, Bohm M et al. Proposal for a revised definition of dilated cardiomyopathy, hypokinetic non-dilated cardiomyopathy, and its implications for clinical practice: a position statement of the ESC working group on myocardial and pericardial diseases. European Heart Journal. 2016;37:1850-58.

Merlo M, Daneluzzi C2,Mestroni L3,Cannatà A2 Historical Terminology, Classifications, and Present Definition of DCM Review from Springer, Cham (CH), 25 Feb 2020

Arbustini E, Favalli V, Toro AD, Serio A. Classification of cardiomyopathy. In: ESC european society of cardiology online (3rd edition).

Kuroda K, Kato TS, Amano A. Hypertensive cardiomyopathy: A clinical approach and literature review. 2015.

Jia G, Hill MA, Sower JR. Diabetic Cardiomyopathy. An Update of Mechanisms Contributing to This Clinical Entity. Circ Res. 2018;122:624-38.

Espinola-Zavaleta N, Soto ME, Castellanos LM, Játiva-Chávez S. Non-compacted cardiomyopathy: clinical-echocardiographic study Cardiovascular Ultrasound. 2006;35(4).

Lo Q, L. Echocardiographic evaluation of diastolic heart failure. Australas J Ultrasound Med. 2010;13(1):14-26.

Broch K, Andreassen AK, Hopp E, Leren TP. Results of comprehensive diagnostic work-up in ‘idiopathic’ dilated cardiomyopathy Open Heart. 2015;2(1):e000271.

Grant ADM, Negishi K, Negishi T, Collier P. Grading diastolic function by echocardiography: hemodynamic validation of existing guidelines. Cardiovasc Ultrasound. 2015;13:28.

DeMaria A, Blanchard DG. The echocardiogram, Cardiomyopathies. HURSTS THE HEART 14th edition. 2017;430-33.

Borlaug BA, Paulus WJ. Heart failure with preserved ejection fraction : pathophysiology, diagnosis, and treatment Eur Heart J. 2011;32(6):670-79.

Oktay A, Shah SJ. Diagnosis and Management of Heart Failure with Preserved Ejection Frac-tion: 10 Key Lessons Curr Cardiol Rev. 2015;11(1):42-52.

Mentz RJ, Khouri MG. Longitudinal Strain in Heart Failure With Preserved Ejection Fraction Is There a Role for Prognostication? Circulation. 2015;132:368-70.

Røe AT, Sjaastad I, Louch WE. Heart failure with preserved ejection fraction Review Tidsskr Nor Laegeforen. 2017;137(18).

Harper, Patel HC, Lyon AR. Heart failure with preserved ejection fraction Clin Med (Lond). 2018;18(Suppl 2):s24-29.

Mitter SS, Shah SJ, Thomas JD. A Test in Context E/A and E/e/ to Assess Diastolic Dysfunction and LV Filling Pressure. JACC. 2017;2017(69):1451-64.

Plitt GD, Spring JT, Moulton MJ, Agrawal DK. Mechanisms, diagnosis, and treatment of heart failure with preserved ejection fraction and diastolic dysfunction. Expert Rev Cardiovasc Ther. 2018;16(8):579-89.

Gevaert AB, Boen JRA, Segers VF, Craenenbroeck EMV. Heart Failure With Preserved Ejection Fraction: A Review of Cardiac and Noncardiac Pathophysiology. Front Physiol. 2019;10:638.

Hiebert JB, Vacek J, Shah Z. Use of Speckle Tracking to Assess Heart Failure with Preserved Ejection Fraction. J Cardiol. 2019;74(5):397-402.

Fang S, Zhang ZD, Wang Y. Predictive value of left ventricular myocardial strain by four‐dimensional speckle tracking echocardiography combined with red cell distribution width in heart failure with preserved ejection fraction Echocardiography. 2019;36(6):1074-83.

Alvarez P, Tang W. Recent Advances in Understanding and Managing Cardiomyopathy Version 1. F1000 Res. 2017;6:1659.

Breitenstein A, Steffel J. Devices in Heart Failure Patients—Who Benefits From ICD and CRT? Review article, Front. Cardiovasc Med. 2019.

Maron BJ, Towbin JA, Thiene G. An American Heart Association Scientific Statement From the Council on Clinical Cardiology, Heart Failure and Transplantation Committee; Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups; and Council on Epidemiology and Prevention Circulation. 2006;113:1807-816.

Lehnart SE, Ackerman MJ, Benson Jr DW, Brugada R. Inherited arrhythmias: a National Heart, Lung, and Blood Institute and Office of Rare Diseases workshop consensus report about the diagnosis, phenotyping, molecular mechanisms, and therapeutic approaches for primary cardiomyopathies of gene mutations affecting ion channel function Circulation. 2007;116(20):2325-45.

Carolyn Y. Ho and Scott D. Solomon, A Clinician’s Guide to Tissue Doppler Imaging: Circulation. 2006;113:e396–8