Congestive Heart Failure
Comparison of frequencies of left ventricular systolic and diastolic heart failure in chinese living in Hong Kong

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Abstract

There is a wide variation (13% to 74%) in the reported prevalence of heart failure associated with normal left ventricular (LV) systolic function (diastolic heart failure). There is no published information on this condition in China. To ascertain the prevalence of diastolic heart failure in this community, 200 consecutive patients with the typical features of congestive heart failure were studied with standard 2-dimensional Doppler echocardiography. A LV ejection fraction (LVEF) >45% was considered normal. The results showed that 12.5% had significant valvular heart disease. Of the remaining 175 patients, 132 had a LVEF >45% (75%). Therefore, 66% of patients with a clinical diagnosis of heart failure had a normal LVEF. Heart failure with normal LV systolic function was more common than systolic heart failure in those >70 years old (65% vs 47%; p = 0.015). Most (57%) had an abnormal relaxation pattern in diastole and 14% had a restrictive filling pattern. In the systolic heart failure group, a restrictive filling pattern was more common (46%). There were no significant differences in the sex distribution, etiology, or prevalence of LV hypertrophy between these 2 heart failure groups. In conclusion, heart failure with a normal LVEF or diastolic heart failure is more common than systolic heart failure in Chinese patients with the symptoms of heart failure. This may be related to older age at presentation and the high prevalence of hypertension in this community.

Section snippets

Methods

The Prince of Wales Hospital is a major teaching and district hospital serving a community of 1.5 million people. At the time of this study there was no other fully functional acute hospitals in this area, and community care was minimal. It is therefore likely that all patients who developed clinically significant heart failure were referred to this hospital. Therefore, we prospectively studied all patients admitted over a 9-month period with the clinical diagnosis of heart failure. The records

Results

Fifteen patients (12.5%) of the total population had chronic rheumatic heart disease or significant valvular heart disease of at least moderate severity. Of the remaining 175 patients studied, 132 patients had a LVEF of ≥45% (75%). Therefore, 66% of patients with a clinical diagnosis of heart failure had a normal LVEF (the normal systolic LV failure group) compared with the systolic LV failure group in which there was impaired LV function.

Discussion

This study suggests that heart failure with normal LV systolic function or diastolic heart failure is more common than systolic heart failure in Hong Kong Chinese patients with the typical symptoms and signs of heart failure. In part this may be explained by the greater age of our patients at the time of presentation. A lower estimate of prevalence (13%) was found in the Veterans Administration Heart Failure Trial, where the average age was 59 years, and the higher estimates (about 60%) came

Acknowledgements

We are grateful to K.K. Wong, MPhil, from the Centre for Clinical Trials and Epidemiological Research, Chinese University of Hong Kong, for his statistical advice and helpful assistance.

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