Coronary artery disease in patients with heart failure and preserved systolic function

Patients hospitalized with congestive heart failure (CHF) and preserved left ventricular (LV) systolic function appear to have similar hospital readmission rates for CHF as those with heart failure due to systolic dysfunction. 1,2 However, mortality rates in this condition, although substantial, have been reported to be both lower than 3,4 and similar to(2,5,6) those with CHF and systolic dysfunction. These disparate findings may be explained by the prevalence of coronary artery disease (CAD) in the populations under study. In a study of elderly CHF patients (mean age 84 +/- 6 years), those with CAD and preserved systolic 7 function had a 1-year mortality rate of 22%. In the Coronary Artery Surgery Study registry database, the extent of CAD in patients who had CHF symptoms with normal ejection fractions determined prognosis (Figure 1); the 6-year survival rate for patients who had 3-vessel CAD was 68% compared with 83% in those with 1- or 2-vessel disease and 92% for CHF patients without CAD.(8) The major cause of CHF due to systolic dysfunction in the USA is CAD.(9) Although a tremendous amount of data exists regarding the evaluation and management of CHF due to LV systolic dysfunction, relatively few data exist on the syndrome of CHF with preserved LV systolic function, and, in particular, the prevalence and significance of CAD in this patient population is not well defined. The purpose of this editorial is to review whether there is sufficient evidence to make a case for systematic evaluation of CAD in patients with CHF and preserved systolic function, since the finding of significant CAD in this patient population may impact therapeutic strategies.