Abstract
Studies have demonstrated that diastolic dysfunction is frequently present in asymptomatic community-based individuals, especially in the elderly with hypertension, coronary artery disease, and diabetes. The presence of diastolic dysfunction is a predictor for the development of heart failure (HF) and confers a higher risk of mortality. These findings have raised the question of whether treating preclinical diastolic dysfunction will be helpful in preventing or delaying the onset of clinical HF and mortality, as has been proven with treatment of asymptomatic left ventricular systolic dysfunction. In addition, in some individuals, diastolic dysfunction in the presence of a normal ejection fraction is associated with exercise intolerance as well as symptomatic clinical HF, referred to as diastolic HF. Patients with diastolic HF, who are more often elderly women, have a significant mortality and morbidity burden compared with agematched controls. Studies that further our understanding of mechanisms underlying diastolic dysfunction and diastolic HF will provide potential new targets for development of effective therapies for these conditions.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References and Recommended Reading
Gaasch WH, Zile MR: Left ventricular diastolic dysfunction and diastolic heart failure. Annu Rev Med 2004, 55:373–394.
Redfield MM: Understanding “diastolic” heart failure. N Engl J Med 2004, 350:1930–1931.
Hay I, Rich J, Ferber P, et al.: The role of impaired myocardial relaxation in the production of elevated left ventricular filling pressure. Am J Physiol Heart Circ Physiol 2005, 288:H1203-H1208.
Maurer MS, Spevack D, Burkhoff D, Kronzon I: Diastolic dysfunction: can it be diagnosed by Doppler echocardiography? J Am Coll Cardiol 2004, 44:1543–1549.
Angeja BG, Grossman W: Evaluation and management of diastolic heart failure. Circulation 2003, 107:659–663.
Kass DA, Bronzwaer JG, Paulus WJ: What mechanisms underlie diastolic dysfunction in heart failure? Circ Res 2004, 94:1533–1542.
Litwin SE, Grossman W: Diastolic dysfunction as a cause of heart failure. J Am Coll Cardiol 1993, 22:49A-55A.
Zile MR, Gaasch WH: Mechanical loads and the isovolumic and filling indices of left ventricular relaxation. Prog Cardiovasc Dis 1990, 32:333–346.
Bell SP, Nyland L, Tischler MD, et al.: Alterations in the determinants of diastolic suction during pacing tachycardia. Circ Res 2000, 87:235–240.
Cazorla O, Freiburg A, Helmes M, et al.: Differential expression of cardiac titin isoforms and modulation of cellular stiffness. Circ Res 2000, 86:59–67.
Zile MR, Richardson K, Cowles MK, et al.: Constitutive properties of adult mammalian cardiac muscle cells. Circulation 1998, 98:567–579.
Zile MR, Brutsaert DL: New concepts in diastolic dysfunction and diastolic heart failure: Part I: diagnosis, prognosis, and measurements of diastolic function. Circulation 2002, 105:1387–1393.
Ommen SR, Nishimura RA: A clinical approach to the assessment of left ventricular diastolic function by Doppler echocardiography: update 2003. Heart 2003, 89:18iii-23iii. A review of echocardiographic modalities utilized for the measurement of diastolic dysfunction.
Young BA, Pugh JA, Maynard C, Reiber G: Diabetes and renal disease in veterans. Diabetes Care 2004, 27:B45-B49.
Zile MR, Gaasch WH, Carroll JD, et al.: Heart failure with a normal ejection fraction: is measurement of diastolic function necessary to make the diagnosis of diastolic heart failure? Circulation 2001, 104:779–782.
Bella JN, Palmieri V, Roman MJ, et al.: Mitral ratio of peak early to late diastolic filling velocity as a predictor of mortality in middle-aged and elderly adults: the Strong Heart Study. Circulation 2002, 105:1928–1933.
Aurigemma GP, Gottdiener JS, Shemanski L, et al.: Predictive value of systolic and diastolic function for incident congestive heart failure in the elderly: the Cardiovascular Health Study. J Am Coll Cardiol 2001, 37:1042–1048.
Wachtell K, Bella JN, Rokkedal J, et al.: Change in diastolic left ventricular filling after one year of antihypertensive treatment: The Losartan Intervention For Endpoint Reduction in Hypertension (LIFE) Study. Circulation 2002, 105:1071–1076.
Redfield MM, Jacobsen SJ, Burnett JC, Jr., et al.: Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic. JAMA 2003, 289:194–202. Cross-sectional study of the prevalence and prognostic implication of diastolic and systolic dysfunction in the community.
Aurigemma GP, Gaasch WH, McLaughlin M, et al.: Reduced left ventricular systolic pump performance and depressed myocardial contractile function in patients > 65 years of age with normal ejection fraction and a high relative wall thickness. Am J Cardiol 1995, 76:702–705.
Kitzman DW, Higginbotham MB, Cobb FR, et al.: Exercise intolerance in patients with heart failure and preserved left ventricular systolic function: failure of the Frank-Starling mechanism. J Am Coll Cardiol 1991, 17:1065–1072.
Kitzman DW: Diastolic heart failure in the elderly. Heart Fail Rev 2002, 7:17–27.
Little WC, Kitzman DW, Cheng CP: Diastolic dysfunction as a cause of exercise intolerance. Heart Fail Rev 2000, 5:301–306.
Warner JG, Jr., Metzger DC, Kitzman DW, et al.: Losartan improves exercise tolerance in patients with diastolic dysfunction and a hypertensive response to exercise. J Am Coll Cardiol 1999, 33:1567–1572.
Senni M, Redfield MM: Heart failure with preserved systolic function. A different natural history? J Am Coll Cardiol 2001, 38:1277–1282.
Hogg K, Swedberg K, McMurray J: Heart failure with preserved left ventricular systolic function, epidemiology, bdclinical characteristics, and prognosis. J Am Coll Cardiol 2004, 43:317–327. Recent review of the epidemiology of HF with preserved EF.
Thomas MD, Fox KF, Coats AJ, Sutton GC: The epidemiological enigma of heart failure with preserved systolic function. Eur J Heart Fail 2004, 6:125–136.
Zile MR, Baicu CF, Gaasch WH: Diastolic heart failure--abnormalities in active relaxation and passive stiffness of the left ventricle. N Engl J Med 2004, 350:1953–1959.
Avolio AP, Deng FQ, Li WQ, et al.: Effects of aging on arterial distensibility in populations with high and low prevalence of hypertension: comparison between urban and rural communities in China. Circulation 1985, 71:202–210.
Kawaguchi M, Hay I, Fetics B, Kass DA: Combined ventricular systolic and arterial stiffening in patients with heart failure and preserved ejection fraction: implications for systolic and diastolic reserve limitations. Circulation 2003, 107:714–720.
Yu CM, Lin H, Yang H, et al.: Progression of systolic abnormalities in patients with “isolated” diastolic heart failure and diastolic dysfunction. Circulation 2002, 105:1195–1201.
Bruch C, Gradaus R, Gunia S, et al.: Doppler tissue analysis of mitral annular velocities: evidence for systolic abnormalities in patients with diastolic heart failure. J Am Soc Echocardiogr 2003, 16:1031–1036.
Vasan RS, Levy D: Defining diastolic heart failure: a call for standardized diagnostic criteria. Circulation 2000, 101:2118–2121.
European Study Group on Diastolic Heart Failure: How to diagnose diastolic heart failure. Eur Heart J 1998, 19:990–1003.
Kitzman DW, Gardin JM, Gottdiener JS, et al.: Importance of heart failure with preserved systolic function in patients > or = 65 years of age. CHS Research Group. Cardiovascular Health Study. Am J Cardiol 2001, 87:413–419.
Devereux RB, Roman MJ, Liu JE, et al.: Congestive heart failure despite normal left ventricular systolic function in a population-based sample: the Strong Heart Study. Am J Cardiol 2000, 86:1090–1096.
Vasan RS, Larson MG, Benjamin EJ, et al.: Congestive heart failure in subjects with normal versus reduced left ventricular ejection fraction: prevalence and mortality in a population-based cohort. J Am Coll Cardiol 1999, 33:1948–1955.
Yusuf S, Pfeffer MA, Swedberg K, et al.: Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: the CHARM-Preserved Trial. Lancet 2003, 362:777–781.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Deswal, A. Diastolic dysfunction and diastolic heart failure: Mechanisms and epidemiology. Curr Cardiol Rep 7, 178–183 (2005). https://doi.org/10.1007/s11886-005-0074-7
Issue Date:
DOI: https://doi.org/10.1007/s11886-005-0074-7