ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult-summary article : A report of the American college of cardiology/american heart association task force on practice guidelines (writing committee to update the 2001 guidelines for the evaluation and management of heart failure)

IIb C TABLE 7 Recommendations for Treatment of Patients With Heart Failure and Normal Left Ventricular Ejection Fraction Incorrect diagnosis of HF Inaccurate measurement of LVEF Primary valvular disease Restrictive (infiltrative) cardiomyopathies Amyloidosis, sarcoidosis, hemochromatosis Pericardial constriction Episodic or reversible LV systolic dysfunction Severe hypertension, myocardial ischemia HF associated with high metabolic demand (high-output states) Anemia, thyrotoxicosis, arteriovenous fistulae Chronic pulmonary disease with right HF Pulmonary hypertension associated with pulmonary vascular disorders Atrial myxoma Diastolic dysfunction of uncertain origin Obesity TABLE 8 Differential Diagnosis in a Patient With Heart Failure and Normal Left Ventricular Ejection Fraction HF indicates heart failure; LV, left ventricular; and LVEF, left ventricular ejection fraction. Absolute indications in appropriate patients For hemodynamic compromise due to HF Refractory cardiogenic shock Documented dependence on IV inotropic support to maintain adequate organ perfusion Peak Vo2 less than 10 ml per kg per min with achievement of anaerobic metabolism Severe symptoms of ischemia that consistently limit routine activity and are not amenable to coronary artery bypass surgery or percutaneous coronary intervention Recurrent symptomatic ventricular arrhythmias refractory to all therapeutic modalities Relative indications Peak Vo2 11 to 14 ml per kg per min (or 55% of predicted) and major limitation of the patient's daily activities Recurrent unstable ischemia not amenable to other intervention Recurrent instability of fluid balance/renal function not due to patient noncompliance with medical regimen Insufficient indications Low left ventricular ejection fraction History of functional class III or IV symptoms of HF Peak Vo2 greater than 15 ml per kg per min (and greater than 55% of predicted) without other indications TABLE 9 Indications for Cardiac Transplantation HF indicates heart failure; IV, intravenous; and Vo2, oxygen consumption per unit time.