2
• The clinical syndrome of heart failure (HF) may result from disorders of
the pericardium, myocardium, endocardium, heart valves, or great vessels
or from certain metabolic abnormalities, but most patients with HF have
symptoms due to impaired left ventricular (LV) myocardial function.
▶ Because some patients present without signs or symptoms of volume
overload, the term "heart failure" is preferred over "congestive heart
failure."
• HF is a complex clinical syndrome that results from any structural or
functional impairment of ventricular filling or ejection of blood.
• It should be emphasized that HF is not synonymous with either
cardiomyopathy or LV dysfunction; these latter terms describe possible
structural or functional reasons for the development of HF.
• HF may be associated with a wide spectrum of LV functional
abnormalities, which may range from patients with normal LV size and
preserved ejection fraction (EF) to those with severe dilatation and/or
markedly reduced EF.
• In most patients, abnormalities of systolic and diastolic dysfunction
coexist, irrespective of EF.
• The EF is considered important in classification of patients with HF
because of differing patient demographics, comorbid conditions,
prognosis, and response to therapies and because most clinical trials have
selected patients based on EF.
▶ EF values are dependent on the imaging technique employed, method
of analysis, and operator. Because other techniques may indicate
abnormalities in systolic function among patients with a preserved EF, it
is preferable to use the terms "preserved EF" (HFpEF) or "reduced EF"
(HFrEF) over preserved or reduced "systolic function."
• In view of the advances in medical therapy across the spectrum of
cardiovascular diseases, the American College of Cardiolog y Foundation/
American Heart Association (ACCF/AHA) guideline task force has
designated the term "guideline-directed medical therapy" (GDMT)
to represent optimal medical therapy—a combination of lifestyle
modifications and medications—as defined by their guideline-directed
therapies (primarily Class I)(see Figure 3).
• This guideline outlines a comprehensive approach to the management of
HF by ACCF/AHA stage of HF development (see algorithmic summary
in Figure 3).
Key Points
