Clinical evaluation of new methods for the assessment of heart failure

Although every physician seems to know the term "heart failure", there is no general agreement on its definition. Due to the complex nature of heart failure and the changing Insights into its pathophysiology over time, many different definitions exist. l.' Some focus on clinical presentations, while others highlight specific features of healt failure based on physiological concepts. In the studies which constitute this theSiS, the clinical definition of heart failure as proposed by the Task Force on Heart Failure of the European Sociery of Cardiology has been used.' In accordance with this definition patients were diagnosed as having heart failure when they had symptoms of heart failure, typically dyspnoea, fatigue or ankle swelling, and objective evidence of left ventricular dysfunction. This diagnosis was considered to be reinforced by an adequate response to treatment directed towards heart failure. It should be noted that patients with heart failure who have responded to treatment may be entirely asymptomatic. In the studies presented in this thesis, these patients were labelled as having asymptomatic left ventricular dysfunction. Several different adjectives can be used to describe heart failure. These include acute and chronic healt failure, congestive healt failure and systolic and diastolic healt failure. In its acute form, heart failure presents with rapidly developing symptoms and signs, such as dyspnoea, orthopnoea, pulmonary rates or peripheral oedema. Chronic heart failure, on the other hand, develops gradually, the symptoms are aspecific (e.g. fatigue) and the physical signs may be absent despite elevation of ventricular filling pressures.6 Since many patients with chronic healt failure who are treated with diuretics do not have physical signs of congestion, the term healt failure should be used instead of congestive heart failure. Although healt failure is often assumed to be associated with impaired left ventricular systolic function, diastolic heart failure is increasingly being recognised as a separate cllnlcal entity.' This issue, however, is beyond the scope of the present thesis, which focuses on patients with chronic heart failure and left ventricular systolic dysfunction.

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