European Journal of Internal Medicine 20 (2009) 313 318

www.elsevier.com/locate/ejim

Original article

Prediction clinical profile to distinguish between systolic and diastolic heart

failure in hospitalized patients
Ana Maestrea,, Vicente Gilb , Javier Gallegoa , Miguel Garcac ,
Fernando Garca de Burgosc , Alberto Martn-Hidalgoa
a

Internal Medicine Department. Hospital General Universitario de Elche, Spain

b
Universidad Miguel Hernndez, Spain
Cardiology Section, Internal Medicine Department, Hospital General Universitario de Elche, Spain
Received 3 December 2007; received in revised form 12 August 2008; accepted 3 September 2008
Available online 26 October 2008

Abstract
Background: In recent decades, the growing incidence of patients with heart failure who have preserved systolic function, underlines the need to
differentiate between heart failure due to diastolic dysfunction and that due to systolic dysfunction.
Objective: To develop a prediction profile of clinical parameters that enables clinicians to differentiate between patients with systolic and diastolic
heart failure.
Methods: 164 patients admitted for congestive heart failure to the cardiology department of an academic tertiary care hospital, whose left
ventricular systolic and diastolic function had been evaluated echocardiographically and who satisfied the Framingham criteria for heart failure,
were prospectively recruited. All patients answered a questionnaire which included, in addition to other clinical variables, the Framingham criteria.
Results: Patients with diastolic heart failure (61.6%) were more likely to be older, female, and to present left ventricular hypertrophy (LVH), with a
lower proportion of smokers, alcohol drinkers, coronary disease, q wave and left bundle branch block (all p b 0.005). The predicting model
obtained on the logistic regression analysis was very significant, with three variables and 72.3% of correct predictions (x2 value = 40,457,
p b 0.001). These three variables, predictors of diastolic as opposed to systolic heart failure, were female sex (OR = 3.546), left ventricle
hypertrophy (OR = 4.011) and absence of coronary disease (OR = 3.547).
Conclusion: Three variables which can be easily evaluated, female sex, left ventricular hypertrophy and presence or absence of coronary disease,
may enable clinicians to differentiate between patients with systolic or diastolic heart failure.
2008 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
Keywords: Clinical characteristics; Systolic and diastolic dysfunction; Heart failure; Hospitalized patients

1. Introduction
Heart failure is one of the most serious public health
problems in the Western world and most authors consider that
we are facing the greatest cardiovascular epidemic of the 21st
century [1]. This has an increasing impact on the health of the

Corresponding author. Servicio de Medicina Interna, Hospital General

Universitario de Elche, Camino de la Almazara s/n. 03203, Elche, Spain. Tel.:
+34 966679318.
E-mail address: amaestrep@gmail.com (A. Maestre).

population since not only the incidence but also the prevalence
of heart failure is raising, with the resulting increase in
morbidity, mortality and healthcare costs [24].
Approximately 1.52% of the population have heart failure,
and the prevalence rises to 610% in patients over 65 years of
age [2,5,6], in whom it is the main reason for hospital admission
[3,7]. The annual incidence found in the Framingham study rose
from 0.3% in men aged 50 to 59 years to 2.7% in men aged 80
to 89 [6]. Despite medical advances, the mortality is still high
and heart failure is currently the third cause of cardiovascular
mortality in developed countries.
In Spain, there is no data available on the true incidence of
heart failure in the community. With regard to prevalence, a

0953-6205/$ - see front matter 2008 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
doi:10.1016/j.ejim.2008.09.001

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A. Maestre et al. / European Journal of Internal Medicine 20 (2009) 313318

population based study from Asturias found a prevalence of 5%,

ranging from less than 1% in patients under 50 years old to 18%
in those over 80 years old [8]. There is more information about
morbidity, based mainly on hospital records and series [9].
Hospital admission for heart failure increased by 47% between
1980 and 1993. This increase was most pronounced in the over
65-year-old population, in which it was the main reason for
admission to hospital and accounted for 5% of all hospital
admissions. Thus, heart failure is also a significant demographic
and healthcare burden for the Spanish population [1].
Few diseases have experienced so many changes in their
epidemiology, physiopathological basis and therapeutic
approach in recent decades as heart failure. One of the main
epidemiological changes is the increasing prevalence of heart
failure in which systolic function is preserved [10,11], as shown
by numerous reports published in recent years, based on the
incidence in the community [7,12], transversal population
studies on prevalence [5,8,1315] or hospital cohorts [1620].
The heterogeneity of published studies, the use of different
diagnostic criteria and cut-off points for left ventricular ejection
fraction, and the fact that left ventricular diastolic function is
rarely evaluated, are only some of the reasons why the
epidemiology of heart failure has not been clearly established.
Although clinical features and physical examination have
failed to consistently discriminate between diastolic and systolic
heart failure in previous studies [21], in clinical practice it could
be useful to be able to differentiate between the two conditions
by means of clinical signs and symptoms.
The objective of this study was to develop a prediction
profile of clinical parameters that could make it possible to
differentiate between patients with systolic heart failure and
those with diastolic heart failure in real healthcare conditions.

2. Patients and methods

This was a prospective observational study. We included all
patients referred to the cardiology section of the University
General Hospital of Elche who were admitted to hospital for
congestive heart failure between 1 June 2002 and 31 May 2003,
whose left ventricular systolic and diastolic function was
evaluated echocardiographically within two days of admission,
and who satisfied the modified Framingham criteria for
congestive heart failure [22]. The criteria advocated by the
European Study Group on Diastolic Heart Failure were used to
measure diastolic dysfunction. This study group proposes a
restrictive approach in which diagnosis of diastolic heart failure
requires a combination of clinical signs and symptoms of heart
failure, preserved or slightly depressed systolic function and
evidence of anomalies in ventricular relaxation, filling or
distension. Systolic dysfunction was based on a left ventricular
ejection fraction of less than 45% [23,24].
Exclusion criteria were those derived from the patient (senile
dementia, being bed-ridden for a long time due to noncardiological problems, cor pulmonale or primary state of
volume overload) and those derived from echocardiography
(poor echogenic window or moderate-severe valvulopathy).

All patients answered a questionnaire which included, in

addition to other sociodemographic and clinical variables, the
Framingham criteria for heart failure (Appendix A.1). Each
patient underwent a thorough physical examination, an
electrocardiogram, chest radiography, specific laboratory tests
and a transthoracic M-mode, 2-dimensional, Doppler echocardiography. The echocardiograms were performed by a trained
cardiologist who determined whether there were valve abnormalities, left ventricular hypertrophy or pulmonary hypertension.
In addition, volumes, left ventricle diameters and a series of
parameters of ventricular dysfunction, such as left ventricular
ejection fraction and the main indexes of diastolic dysfunction,
were calculated by analysing the morphology of the maximum
transmitral flow velocity curve (Appendix A.2).
Univariate tests of statistical significance for differences in
clinical characteristics were performed. Data for continuous
variables were expressed as means and compared using the
Student's t test. Data for categorical or dichotomous variables
were expressed as percentages and compared using the x2 test
or Fisher's exact test. Multiple logistic regression analysis was
used to determine the strength and significance of clinical
characteristics as predictors of normal versus decreased systolic
function. All statistical tests were 2-sided and a p value of 0.05
was selected for the threshold of statistical significance.
Table 1
Clinical characteristics of patients with systolic heart failure (SHF) and diastolic
heart failure (DHF).
Characteristics

Total
(n = 164)

SHF
(n = 63)

DHF
(n = 101)

P value

Age
Gender

73.02
79 (48.2%)
85 (51.8%)
105 (64.0%)
59 (36.0%)
65 (39.6%)
99 (60.4%)
33 (20.1%)
131 (79.9%)
14 (8.5%)
106 (64.7%)
44 (26.8%)

70.11
43 (68.3%)
20 (31.7%)
35 (55.6%)
28 (44.4%)
22 (34.9%)
41 (65.1%)
14 (22.2%)
49 (77.8%)
9 (14.3%)
31 (49.2%)
23 (36.5%)

74.84
36 (35.6%)
65 (64.4%)
70 (69.3%)
31 (30.7%)
43 (42.6%)
58 (57.4%)
19 (18.8%)
82 (81.2%)
5 (5.0%)
75 (74.2%)
21 (20.8%)

0.003
b0.001

11 (6.7%)
149 (90.9%)
4 (2.4%)

8 (12.7%) 3 (3.0%)
52 (82.5%) 97 (96.0%)
3 (4.8%)
1 (1.0%)

0.014

51 (31.1%)
113 (68.9%)
31 (18.9%)
133 (81.1%)
146.01
82.41
65 (39.8%)
98 (60.2%)
17 (11.1%)
137 (88.9%)
30 (19.2%)
126 (80.8%)

28 (44.4%)
35 (55.6%)
12 (19.0%)
51 (81.0%)
134.79
80.33
13 (21.0%)
49 (79.0%)
11 (18.6%)
48 (81.4%)
17 (27.9%)
44 (72.1%)

0.005

Male
Female
Hypertension
Yes
No
DM
Yes
No
Hyperlipidemia Yes
No
Smoker
Yes
No
Exsmoker
Alcohol
Yes
No
Exdrinker
CD
Yes
No
Anaemia
Yes
No
SBP
DBP
LVH
Yes
No
Q wave
Yes
No
LBBB
Yes
No

23 (22.8%)
78 (77.2%)
19 (18.8%)
82 (81.2%)
157.23
84.49
52 (51.5%)
49 (48.5%)
6 (6.3%)
89 (93.7%)
13 (13.7%)
82 (86.3%)

0.094
0.412
0.690
0.004

1.000
b0.001
0.225
b0.001
0.032
0.037

DM: Diabetes mellitus; CD: coronary disease; SBP: systolic blood pressure (mm Hg);
DBP: diastolic blood pressure (mm Hg); LVH: Left ventricular hypertrophy; LBBB:
Left bundle branch block

A. Maestre et al. / European Journal of Internal Medicine 20 (2009) 313318

315

Analyses were performed using SPSS statistical software,

version 12.0.

Table 3
Final predicting model for diastolic dysfunction in patients admitted to hospital
with heart failure.

3. Results

Variable

Odds ratio

CI of 95%

Female sex
LVH
Absence of coronary disease

3.546
4.011
3.547

(1.7247.297)
0.001
(1.9168.399)
b0.001
(1.7127.347)
b0.001
x2 value = 40,457, p b 0.001
Correctly classified: 72.3%

The final sample consisted of 164 patients, of whom 85 were

women (51.8%) and 79 men (48.2%), with a mean age of
73 years.
With regard to the prevalence of classical vascular risk
factors, 105 patients (64.0%) were hypertensive, 65 (39.6%)
were diabetic, 33 (20.1%) had hyperlipidemia, 14 (8.5%) were
active smokers, and 44 (26.8%) ex-smokers. In addition, 11
patients (6.7%) had alcohol abuse and 61 (37.2%) were obese.
Regarding main associated co-morbidities, coronary disease
was present in 31.1% of the population studied, whereas chronic
obstructive pulmonary disease and anaemia were both present
in 18.9%.
Echographic data showed systolic dysfunction in 63 (38.4%)
and diastolic dysfunction in 101 (61.6%) of the 164 patients.
The clinical characteristics of the study patients are shown in
Table 1. Patients with diastolic heart failure were older
(p = 0.003), more likely to be women (p b 0.001), with higher
levels of systolic blood pressure (p b 0.001), more likely to have
left ventricle hypertrophy (p b 0.001) and with a lower
proportion of smokers (p = 0.004), alcohol abuse (p = 0.014),
coronary disease (p = 0.005), total left bundle branch block
(p = 0.037) and q waves (p = 0.032) compared with patients with
systolic failure.
Table 2
Distribution of the Framingham criteria in patients with systolic heart failure
(SHF) and diastolic heart failure (DHF).
Framingham criteria

Total (n = 164) SHF (n = 63) DHF (n = 101) p value

PND

147 (89.6%)
17 (10.4%)
34 (21.0%)
128 (79.0%)
135 (82.3%)
29 (17.7%)
144 (88.3%)
19 (11.7%)
19 (11.6%)
145 (88.4%)
52 (37.7%)
86 (62.3%)
27 (16.6%)
136 (83.4%)
111 (67.7%)
53 (32.3%)
32 (19.5%)
132 (80.5%)
164 (100%)
0 (0%)
42 (30.7%)
95 (69.3%)
62 (38.0%)
101 (62.0%)
43 (26.4%)
120 (73.6%)

Yes
No
NVD
Yes
No
Crackles
Yes
No
Cardiomegaly
Yes
No
APE
Yes
No
S3-Gallop
Yes
No
HJR
Yes
No
Ankle oedema
Yes
No
Nocturnal cough Yes
No
Dyspnoea
Yes
No
Hepatomegaly
Yes
No
PE
Yes
No
Tachycardia
Yes
No

56 (88.9%)
7 (11.1%)
14 (22.2%)
49 (77.8%)
51 (81.0%)
12 (19.0%)
59 (95.2%)
3 (4.8%)
5 (7.9%)
58 (92.1%)
26 (46.4%)
30 (53.6%)
12 (19.0%)
51 (81.0%)
39 (61.9%)
24 (38.1%)
11 (17.5%)
52 (82.5%)
63 (100%)
0 (0%)
19 (35.8%)
34 (64.2%)
19 (30.6%)
43 (69.4%)
17 (27.4%)
45 (7.6%)

91 (90.1%)
10 (9.9%)
20 (20.2%)
79 (79.8%)
84 (83.2%)
17 (16.8%)
85 (84.2%)
16 (15.8%)
14 (13.9%)
87 (86.1%)
26 (31.7%)
56 (68.3%)
15 (15.0%)
85 (85.0%)
72 (71.3%)
29 (28.7%)
21 (20.8%)
80 (79.2%)
101 (100%)
0 (0%)
23 (27.4%)
61 (72.6%)
43 (42.6%)
58 (57.4%)
26 (25.7%)
75 (74.3%)

0.798
0.844
0.834
0.043
0.320
0.107
0.522
0.233
0.688

0.343
0.138
0.856

PND: Paroxysmal nocturnal dyspnoea; NVD: Neck vein distention; APE: Acute
pulmonary oedema; HJR: Hepatojugular reflux; PE: Pleural effusion.

p value

LVH: Left ventricular hypertrophy.

Logistic regression analysis.

The presence of the Framingham clinical criteria was

compared in both groups by means of a univariate analysis
(Table 2). The distribution of the Framingham criteria only
showed significant differences in cardiomegaly, which was
more frequent in the group of systolic heart failure (p = 0.043).
The prediction model obtained on the multiple logistic
regression analysis (Table 3) was very significant (p b 0.001),
and made it possible to distinguish between patients with
diastolic heart failure and systolic heart failure using three
variables with a good prediction potential (correct classification
in 72.3% of cases). These three variables, predictors of diastolic
as opposed to systolic heart failure, were female sex
(OR = 3.546), left ventricular hypertrophy (OR = 4.011) and
absence of coronary disease (OR = 3.547).
4. Discussion
In recent decades, the growing incidence of heart failure with
preserved systolic function underlines the need to differentiate
between heart failure due to diastolic dysfunction and that due
to systolic dysfunction [25]. In most of the published studies,
both groups are defined using the same echocardiographic
parameterleft ventricular ejection fractionwithout specifically evaluating the indexes of diastolic function. This is the
main reason why diastolic heart failure is not referred to as such
but rather as heart failure with preserved ejection fraction
[11,16,17].
Very few studies objectively evaluate diastolic function
[14,15] and all that do, except for one recently published study
that assess this parameter in hospitalized patients [26], have
been performed in a community setting. In European population, we found only one study by the German group of Fischer
et al. which evaluated the prevalence of left ventricular diastolic
dysfunction in the community using echocardiography [13].
Our study differs from others in that it includes only patients
with heart failure confirmed on echocardiography, and determines
not only the ejection fraction but also diastolic ventricular
dysfunction. In the present study, more than half (61.6%) of the
individuals had diastolic heart failure. Patients with diastolic heart
failure were older, there was a greater proportion of women, more
likely to have left ventricular hypertrophy, fewer smokers and
alcohol drinkers, less coronary artery disease and fewer q waves
or total left bundle branch block, than in patients with systolic
heart failure. In addition, patients with diastolic heart failure were
more likely to have arterial hypertension and diabetes mellitus,

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A. Maestre et al. / European Journal of Internal Medicine 20 (2009) 313318

although the differences did not attain the significance expected.

With regard to the distribution of the Framingham criteria, no
significant differences were found except for cardiomegaly.
However, the presence of third sound and hepatomegaly did tend
to be greater in the systolic dysfunction group (46.4%), as has
been reported in prior studies [27,28].
When all the previously mentioned characteristics are
combined, in our sample, female sex, left ventricular hypertrophy
and the absence of coronary artery disease explain almost 75% of
the variability between the diagnosis of diastolic and systolic heart
failure.
Most of these data correspond to a large extent with those
published so far, although some differences should be pointed
out. In our study, the proportion of patients with diastolic heart
failure was 61.6% versus 38.4% with systolic heart failure. This
greater prevalence of patients with diastolic heart failure may be
due to the fact that one of our exclusion criteria was the
existence of moderate or severe valvulopathies, since their
presence prevent the indexes of diastolic dysfunction from
being correctly determined [11,16,29]. However, in other
studies which simply evaluated whether left ventricular ejection
fraction was depressed or preserved, such patients could be
included. Since most of these patients had systolic dysfunction,
this group of patients could increase in number [18,28]. In
addition, the advanced age of our patients might have
contributed to the greater prevalence of diastolic dysfunction.
The first study performed in Spain to evaluate the percentage
of patients with altered or preserved systolic dysfunction and to
describe the clinical characteristics of both groups was carried
out in Santiago de Compostela [9]. In this study, investigators
included all the patients admitted to a cardiology department for
congestive heart failure who fulfilled the Framingham clinical
criteria and whose left ventricular systolic function had been
evaluated. Therefore, the criteria for inclusion were very similar
to ours, except that both groups were defined using a single
echocardiographic parameter, left ventricular ejection fraction,
and without specifically evaluating the diastolic dysfunction
indexes. They reported a mean age of 66.7 years, with a
predominance of men (58.5%) and the presence of arterial
hypertension in 52.2% of the cases, followed by coronary
disease in 45.4%. Fewer than 30% of the patients had preserved
systolic function. When comparing these results with those of
our study, in the former the patients were younger, there were
more men, a lower prevalence of arterial hypertension and more
coronary disease, as well as a smaller proportion of patients with
diastolic heart failure (28.8%). The authors attribute the
differences between their results and those published in other
studies to the fact that, in their hospital, elderly patients with
heart failure not thought to be secondary to coronary disease are
not referred to the cardiology service [9]. It is possible that these
elderly patients, who are controlled by other services, make up
the population sub-group most often described in other studies,
with a predominance of women and greater prevalence of
arterial hypertension. Very recently, this same group published
another study which was an extension of the first [28], over a
study period of 10 years, with results somewhat different. The
mean age in this case was higher (69.4 years versus 66.7 years),

with a higher proportion of patients with preserved systolic

function (39.8% versus 28.8%), although the rest of clinical
characteristics remained the same.
Comparing our results with those reported in other hospital
cohort studies carried out abroad, many similarities are found.
The first retrospective studies showed a clear predominance of
women with heart failure and normal systolic function, which
was consistent throughout the various sub-groups of patients
[18,27]. McDermott et al. published a retrospective review and
provided a prediction model with which they obtained a correct
classification (76%) very similar to ours (72.3%). As in our
study, patients with heart failure and normal left systolic
function were older, more often women and less likely to have a
history of coronary artery disease [27]. Unfortunately, left
ventricular diastolic dysfunction was not assessed again.
Thomas et al. evaluated the usefulness of the clinical history,
physical examination, electrocardiogram and chest X-ray in
differentiating between patients with normal and depressed
systolic function (specific diastolic indexes were not evaluated
in this study). Patients with preserved systolic function were
generally female, older and obese, with higher levels of diastolic
and systolic blood pressure; whereas tachycardia, clinical
symptoms of angina pectoris and alcohol consumption were
more frequent in patients from the other group. On multivariate
analysis, sex and tachycardia were the only clinical variables
showing significant association [16].
The first multicentre prospective study to characterize the clinical profile, hospital stay and treatment of heart failure with normal
ejection fraction concluded that the majority of patients were
women (73%), older than the men in this group and there was a high
percentage of arterial hypertension (78%), left ventricular hypertrophy (82%), diabetes mellitus (46%), and obesity (46%) [17].
Recently, results from two other studies in hospital setting with
similar results have been published. Owan et al. carried out a
retrospective study in patients hospitalized for heart failure to
define secular trends in the prevalence and survival of heart failure
with preserved ejection fraction [26]. These authors did use
specific echocardiographic parameters for diastolic dysfunction
and found that 53% of patients had reduced ejection fraction and
47% normal ejection fraction. In the other study carried out by
Bhatia et al. [20], of the 2802 patients admitted for heart failure,
31% had an ejection fraction above 50%. These patients were
more likely to be older, female, and had a significantly higher
incidence of hypertension and atrial fibrillation than those with
depressed ejection fraction. However, complications, rates of readmission and mortality were similar in both groups.
Finally, potential limitations to our study should be acknowledged to facilitate the interpretation of the results. In order to avoid
any possible measurement bias, extreme care was taken when performing the echocardiography. All the echocardiograms were
performed by an experienced cardiologist using the same equipment. However, we realise that there are a series of circumstances
such as atrial fibrillation, tachycardia or poor echographic window
that can make it difficult to evaluate left ventricular function.
Another measurement bias could arise from the reliability and
consistency of the interviewer when performing the anamnesis and
physical examination of the patients. All the interventions were

A. Maestre et al. / European Journal of Internal Medicine 20 (2009) 313318

Hyperlipidemia
Smoker
Alcohol intake
Coronary artery disease
Anaemia
Symptoms:
Dyspnoea
Acute pulmonary oedema
Nocturnal cough
Dyspnoea on exertion
Physical examination:
Weight
Height
Blood pressure
Heart rate
Temperature
Neck vein distension
Crackles
S3 gallop
Hepatojugular reflux
Ankle oedema
Hepatomegaly
Radiological data:
Cardiomegaly
Pleural effusion
Electrocardiographical data:
Rhythm
Left ventricular hypertrophy
Q wave
Left bundle branch block
Laboratory tests:
Serum cholesterol (mg/dl)
Fibrinogen (mg/dl)
Serum triglycerides (mg/dl)
Haemoglobin (g/dl)
Serum creatinine (mg/dl)
Partial pressure of oxygen (pO2) (mm Hg)

made by the same observer, who underwent training in taking these

measurements in clinical practice. The study might also be limited
by the fact that only echocardiography was used to diagnose diastolic abnormalities, since echographic diastolic indexes are dependent on the cardiac frequency, after-load and pre-load, or the time it
is performed [13]. However, the alternative techniques are invasive
or require exposure to radioisotopes, which means they are not
applicable to all the population. Another limitation could be the use
of a cut-off point of 45% for the left ventricular ejection fraction as
the only index of normal systolic function, since regional or slightly
impaired systolic dysfunction could be overlooked. We used this
value because it was recommended in the Spanish and European
guidelines we decided to use when starting the study [23,24]. A final
limitation could be that treatment and medication of the enrolled
patients was not considered and that results apply to a tertiary
referral centre and may not be applicable to other populations.
In conclusion, in this study three variables that may be easily
assessed, female sex, left ventricular hypertrophy and absence
of coronary disease, enable us to differentiate between patients
with systolic or diastolic heart failure. This clinical predicting
profile of diastolic heart failure is the first to be obtained in a
European population admitted to hospital for heart failure.
Although clinical assessment and non-invasive cardiac
investigations (chest radiography or electrocardiography) are
not a substitute for an objective evaluation of left ventricular
dysfunction, these results may help to make an initial differential
diagnosis between systolic and diastolic heart failure, especially
regarding primary healthcare or non-cardiological specialities
that depend on cardiologists to carry out echocardiograms. The
results could so enhance the clinician's confidence in making a
diagnosis of diastolic heart failure and confirm the characteristics of these patients in the hospital setting.
In the future, it could be of clinical worth to reliably
distinguish these two populations clinically up-front to stratify
treatment strategies appropriately.
5. Learning points
Although clinical features and physical examination have
failed to discriminate consistently between diastolic and
systolic heart failure by clinical assessment in previous
studies, in clinical practice it could be useful to differentiate
between these two conditions.
In this study, three variables easily evaluated: female sex, left
ventricular hypertrophy and presence or absence of coronary
disease, enabled clinicians to differentiate between patients
with systolic or diastolic heart failure.
Appendix A
A.1. Questionnaire
Clinical variables:
Age
Gender
Hypertension
Diabetes mellitus

317

2. Echographic diagnostic criteria for left ventricular

dysfunction
1)
2)
-

Systolic dysfunction:
Depressed left ventricular ejection fraction (LVEF) b45%.
Diastolic dysfunction:
Evidence of abnormal diastolic function indexes:

Slow early left ventricular filling:

On Doppler echocardiography of mitral diastolic flow, in the
apical projection of four cavities:
E/A b 1 and DT N 220 ms, in patients under 50 years of age
E/A b 0.5 and DT N 280 ms, in patients over 50 years of age
In Doppler flow velocity of pulmonary veins:
S/D N 1.5, in patients under 50 years of age.
S/D N 2.5, in patients over 50 years of age.
Slow isovolumetric left ventricular relaxation:
IVRT N 92 ms, in patients under 30 years of age.
IVRT N 100 ms, in patients between 30 and 50 years of age.

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A. Maestre et al. / European Journal of Internal Medicine 20 (2009) 313318

IVRT N 105 ms, in patients over 50 years of age.

S/D: ratio of systolic to diastolic pulmonary venous flow
velocity; this was not determined due to the difficulties involved
in this technique.
Diastolic ventricular dysfunction required the presence of
one or more of the above criteria.
Normal or mildly reduced ejection fraction (LVEF N 45%)
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