Patients With Heart Failure and Normal Left Ventricular Ejection Fraction

CLASS I
(1) Physicians should control systolic and diastolic hypertension in patients with HF and normal LVEF, in accordance with published guidelines.

(2) Physicians should control ventricular rate in patients with HF and normal LVEF and atrial fibrillation.

(3) Physicians should use diuretics to control pulmonary congestion and peripheral edema in patients with HF and normal LVEF.

CLASS IIa
(1) Coronary revascularization is reasonable in patients with HF and normal LVEF and coronary artery disease in whom symptomatic or demonstrable myocardial ischemia is judged to be having an adverse effect on cardiac function.

CLASS IIb
(1) Restoration and maintenance of sinus rhythm in patients with atrial fibrillation and HF and normal LVEF might be useful to improve symptoms.

(2) The use of beta-adrenergic blocking agents, ACEIs, ARBs, or calcium antagonists in patients with HF and normal LVEF and controlled hypertension might be effective to minimize symptoms of HF.

(3) The usefulness of digitalis to minimize symptoms of HF in patients with HF and normal LVEF is not well established.



JACC. 2009; 53; e1-e90