BEDSIDE DIAGNOSIS OF PRESERVED VERSUS IMPAIRED LEFT-VENTRICULAR SYSTOLIC FUNCTION IN HEART-FAILURE

The importance of recognizing symptomatic heart failure with preserved left ventricular (LV) systolic function has only recently been appreciated. To determine its frequency and identify clinical features that make the bedside diagnosis likely, 82 patients admitted for decompensated heart failure were classified into 2 groups based on their LV systolic performance, as defined by fractional shortening (FS): group I (n = 59), with impaired systolic function (fractional shortening <24%), and group II (n = 23) with preserved systolic function (fractional shortening greater-than-or-equal-to 24%). Mean fractional shortening was 15 +/- 5% and 39 +/- 1% for groups I and II, respectively. Female gender (p < 0.05), obesity (p < 0.01) and diastolic blood pressure greater-than-or-equal-to 105 mm Hg (p < 0.05) predominated in group II. Jugular venous distention was identified more frequently in group I (p < 0.05). No statistically significant difference between the 2 groups was noted among various demographic variables (age, duration of symptoms, history of hypertension, ischemic heart disease and heavy alcohol drinking) or physical findings (S3 gallop, edema, cardiomegaly, pulmonary congestion and pulmonary edema). Echocardiographic mean left ventricular dimension measured 6.6 +/- 1 versus 5.0 +/- 1 cm (p < 0.01) and mean posterior wall thickness 1.1 +/- 0.3 versus 1.4 +/- 0.4 cm (p < 0.01) in group I and II, respectively. The combination of diastolic blood pressure greater-than-or-equal-to 105 mm Hg and an absence of jugular venous distention had a high specificity and positive predictive value (100%) for identifying group II patients. It is concluded that, of 82 consecutive patients with symptomatic heart failure admitted to a city hospital, a sizeable portion (28%) have preserved systolic function. The combination of diastolic blood pressure greater-than-or-equal-to 105 mm Hg and the absence of jugular venous distention has high specificity and positive predictive value in identifying heart failure with preserved systolic performance.