© 2004 European Society of Cardiology
Diastolic heart failure. Paroxysmal or chronic?
Department of Cardiology, University of Hull, Castle Hill Hospital Kingston upon Hull HU16 5JQ, UK
* Corresponding author. Tel.: +44-1482-624087; fax: +44-1482-624085. E-mail address: pbanerjee{at}ukonline.co.uk
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Abstract |
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Heart failure with preserved systolic function is considered by some to be synonymous with diastolic heart failure (DHF). Although recent epidemiological studies have suggested that DHF constitutes 30–50% of all patients with heart failure, many cardiologists dealing with ambulant heart failure patients on a daily basis find that the vast majority of heart failure patients have systolic dysfunction. What could be the reasons for this? Referral bias and varying diagnostic thresholds and interpretation of results could be one important reason. Heart failure with preserved systolic function comprises a heterogeneous group of conditions: whilst some patients may truly have DHF, others may have heart failure due to subtle systolic dysfunction (noted on tissue Doppler imaging of the left ventricular long axis). Other patients actually have pulmonary disease, obesity or ischaemic heart disease, and have their symptoms attributed to ‘diastolic heart failure’ on the basis of ‘abnormal’ mitral diastolic flow indices that may, in fact, simply reflect aging. True DHF may be much less prevalent than suggested. A further possibility is that heart failure in patients with diastolic dysfunction might be paroxysmal rather than chronic. This group of patients may present predominantly to acute units like accident and emergency, coronary care units and intensive care units and are, therefore unlikely to figure prominently in the usual outpatient population of chronic systolic left ventricular dysfunction.
Key Words: LV, left ventricular • DHF, diastolic heart failure • LVH, left ventricular hypertrophy • SBP, systolic blood pressure • LVEDP, left ventricular end diastolic pressure • HFPSF, heart failure with preserved systolic function
Received March 26, 2003; Revised February 16, 2004; Accepted February 23, 2004
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