Heart and lung involvement
Figure 1 – Severe left ventricular hypertrophy and grade 1 diastolic heart failure are revealed by echocardiography and Doppler ultrasonography. The apical 4-chamber view shows a thickened left ventricular wall and enlarged left atrium (A). Doppler evaluation shows impaired early diastolic relaxation (E wave) and vigorous atrial contraction (A wave) resulting in an E/A ratio of less than 0.75, which signifies early reduced left ventricular compliance (B). A normal E/A ratio is greater than 1.5, since most of the diastolic filling occurs early in a compliant left ventricle with the atrial component contributing a smaller volume at a lower velocity. (LV, left ventricle; LA, left atrium.)
Heart failure with normal ejection fraction (HFNEF) contributes to the largest number of cases of pulmonary hypertension (PH) in the elderly. Studies have shown that isolated HFNEF is present in 44% to 60% of patients with heart failure.20,21 In contrast to systolic dysfunction, HFNEF results from impaired myocardial relaxation resulting in decreased compliance and impairment of diastolic ventricular filling; the problem is not with ventricular contraction but rather with diastolic relaxation.
The most common causes of HFNEF are coronary artery disease, hypertension, aging, obesity, and aortic stenosis. The diagnosis is based on the presence of heart failure symptoms in the absence of depressed ejection fraction. An echocardiogram with Doppler studies can be useful in diagnosing diastolic dysfunction. The E/A ratio, in which E denotes the early peak mitral diastolic inflow velocity and A denotes the late diastolic peak mitral inflow velocity, can be useful.
Under normal conditions, E is greater than A and the E/A ratio is approximately 1.5. In early diastolic dysfunction, relaxation is impaired and there is vigorous atrial contraction, resulting in an E/A ratio of less than 0.75 (Figure 1). As the disease progresses, left ventricular (LV) compliance is reduced further, which increases early LV filling despite impaired relaxation, resulting in pseudonormalization of the E/A ratio to 1.5. In severe diastolic dysfunction, the E/A ratio is greater than 2 as a result of the LV filling occurring primarily in early diastole.22Source: Pulmonary hypertension in the elderly, part 2: Treatment
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5 comments:
What is a normal EF in Heart Failure, thanks.
Please obtain answer from other websites. Here's info from one website:
Immediately before a heart contraction there is a certain volume of blood within the ventricle. This is called the end-diastolic volume (EDV). After the contraction, there is a certain amount of blood left in the ventricle and this is called the end-systolic volume (ESV). The difference between these (EDV-ESV) is the stroke volume (SV). The ejection fraction (EF) is the SV divided by the EDV (SV/EDV), and is often expressed as a percentage, with normal values being 50-70%. EF can be defined as the amount of blood pumped by the heart into circulation with each heartbeat. Although EF can refer to either the left ventricle or the right ventricle, it is the left ventricular function that is more commonly investigated, because it is the left ventricle that pumps the blood to the body.
Read more: http://www.righthealth.com/topic/Normal_Ejection_Fraction_Heart#ixzz1ScJJc8Xj
An answer from Dr Rahimah Zakaria (rahimah@kck.usm.my)
http://my.clevelandclinic.org/heart/disorders/heartfailure/hfwhatis.aspx
Ejection fraction (EF): a measurement of the amount of blood pumped out of the left ventricle with each heartbeat. In a normal person, the ejection fraction equals about 50 percent or more.
If someone has systolic heart failure, the ejection fraction will equal about 20 to 40 percent, or even less.
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