Usefulness of Doppler echocardiography in the diagnosis of congestive heart failure.

One hundred fifty-one consecutive patients with a diagnosis of congestive heart failure (CHF) referred for echocardiography were prospectively evaluated to (1) define the frequency of normal left ventricular systolic function in a referral-based population with CHF; (2) establish cardiac mechanisms responsible for symptomatology in these patients; and (3) assess the ability to clinically differentiate these subsets of patients based on routine history and physical examination. Of the 151 total patients, 51 (34%) had normal left ventricular systolic function (left ventricular ejection fraction greater than or equal to 55%). Primary valvular disease was present in 4 of these 51 patients (8%), and Doppler echocardiographic evidence of abnormal left ventricular filling (diastolic dysfunction) was evident in 10 (20%). In addition, no predefined resting abnormality was noted in 34 (66%) of them. Despite this finding, 51% of all patients with normal left ventricular systolic function were being treated with digoxin therapy in the absence of atrial arrhythmia. Clinical differentiation of this group of patients from those with abnormal left ventricular systolic function was difficult and may have accounted for this apparently inappropriate treatment. Thus, evaluation of left ventricular function and of causative mechanisms of CHF before initiation of long-term treatment is mandatory.