Evaluation and management of patients with heart failure and preserved left ventricular ejection fraction.

A substantial number of patients with heart failure (HF) have preserved left ventricular ejection fraction (LVEF), variably defined as an LVEF O40%, O45%, or O50%. When these patients have invasive or non-invasive evidence of abnormal diastolic function (either abnormal relaxation, filling or stiffness) they are said to have ‘‘diastolic HF’’. Although the term ‘‘HF with normal LVEF’’ is often used to denote this group, because ‘‘normal’’ is variously defined, ‘‘HF with preserved LVEF’’ will be the active definition in this document. Few randomized clinical trials have been performed in this patient group, but appropriate treatment strategies have been proposed by the American College of Cardiology, American Heart Association, Canadian Society of Cardiology, and the European Society of Cardiology, and are proposed in this document by the Heart Failure Society of America. Patients with a previously reduced LVEF whose LVEF has returned to normal with medical and/or device therapy should not be included in the classification of HF with preserved LVEF, but they should be treated as outlined in Section 7.