Diastolic Heart Failure: Definitions and Terminology

doi:10.1016/j.pcad.2005.02.006

Progress in Cardiovascular Diseases

Volume 47, Issue 5, March–April 2005, Pages 307-313

https://doi.org/10.1016/j.pcad.2005.02.006 Get rights and content

Patients with chronic heart failure can be divided into 2 broad categories: systolic heart failure and diastolic heart failure. There are significant differences in demographics, prognosis, left ventricular structure, as well as systolic and diastolic function between these 2 groups of patients. The purpose of this presentation is to define the terminology used to describe these 2 broad categories of heart failure and to characterize the functional measurements that constitute their pathophysiological mechanisms.

Section snippets

Comparison Between SHF and DHF

Patients with CHF can be divided into 2 broad categories: systolic heart failure (SHF) and DHF. There are significant differences in demographics, prognosis, left ventricular (LV) structure, and function between these 2 groups of patients (Table 1, Table 2).2, 4, 5, 19

Patients with SHF have eccentric remodeling, increased LV diastolic volume, and predominant abnormalities in LV systolic properties including decreased systolic performance, function, and contractility.5, 20, 21 Effective arterial

Acknowledgments

This publication was supported by a grant from the Research Service of the Department of Veterans Affairs (MR Zile) and from the National Heart, Lung, Blood Institute (grant PO1-HL-48788, MR Zile).

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Pathophysiology of Heart Failure With a Preserved Ejection Fraction: Measurements and Mechanisms Causing Abnormal Diastolic Function
2020, Diastology: Clinical Approach to Heart Failure with Preserved Ejection Fraction
Heart failure with preserved ejection fraction (HFpEF) patients have normal LV volume, concentric remodeling, normal chamber systolic function at rest, but clear and common abnormalities in diastolic function. HFpEF patients have abnormalities in diastolic relaxation, filling, recoil, and stiffness/distensibility. Regional systolic abnormalities result in reduced diastolic recoil and increased diastolic pressure. Blunted augmentation in systolic function during exercise results from abnormalities in diastolic distensibility. Invasive and noninvasive, intermittent and continuous, cutaneous, subcutaneous, and vascular measurements of diastolic function can be made in HFpEF. Management that targets diastolic function, specifically diastolic filling pressure, results in reduced symptoms, morbidity, and mortality in HFpEF.
Perioperative Hypertension and Diastolic Dysfunction
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Worsening diastolic function is associated with elevated fasting plasma glucose and increased left ventricularmass in a supra-additive fashion in an elderly, healthy, swedish population
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Citation Excerpt :
Diastolic dysfunction (DD) is the inability of the cardiac myofibrils to rapidly or completely return to their resting length and is characterized by delayed active relaxation and increased left ventricular (LV) stiffness [1].
To examine whether increasing fasting plasma glucose (FPG) levels were associated with worsening left ventricular (LV) diastolic function, independently of LV mass index (LVMI) in elderly, otherwise healthy subjects.
We tested cross-sectional associations between echocardiographically determined averaged E/é ratio/diastolic function, LVMI, cardiovascular risk factors, and FPG categorized as normal (NFG), impaired (IFG), and new-onset diabetes mellitus (DM), in 483 men and 208 women aged 56–79 years without overt cardiovascular disease, who received no cardiovascular, anti-diabetic, or lipid-lowering drugs and had a preserved LV ejection fraction > 50%. Median E/é was significantly higher among subjects with diabetes than those without (8 vs. 7; p = 0.03), as was the prevalence of grade 2 or 3 diastolic dysfunction (25% vs. 16%; p = 0.02). E/é and diastolic function were significantly associated with LVMI (p ≤ 0.002), but not FPG category, on multivariable analysis. However, interaction analyses revealed that increasing LVMI was primarily associated with worsening diastolic function (higher E/é) in subjects with FPG > 6 mmol/L (β = 0.005 for IFG and DM vs. 0.001 for NFG; p = 0.02), whereas increasing systolic blood pressure was primarily associated with worsening diastolic function (higher E/é) in subjects with FPG ≤ 6.9 mmol/L (β = 0.005 for NFG and 0.003 for IFG vs. − 0.001 for DM; p = 0.001).
Diastolic dysfunction was significantly more prevalent among patients with DM than those without. The importance of LVMI increased, but the importance of systolic blood pressure decreased with higher FPG category.
Heart failure with preserved ejection fraction. An ongoing enigma
2014, Cardiology Clinics
A general theory of acute and chronic heart failure
2013, International Journal of Cardiology
Citation Excerpt :
The term diastolic heart failure was introduced to describe a sub-group of patients with heart failure and a preserved ejection fraction (HFPEF) where other cardiac or non-cardiac causes, such as valvular and lung disease, have been excluded. The major abnormality is thought to be due to reduced left ventricular compliance and is effectively Hope's original backward failure hypothesis [20–22]. As ejection fraction is relatively normal in HFPEF it has been assumed that systolic function is also normal and consequently alternative explanations for the heart failure have been sought.
Current concepts of heart failure propose multiple heterogeneous pathophysiological mechanisms. Recently a theoretical framework for understanding chronic heart failure was suggested. This paper develops this framework to include acute heart failure syndromes.
We propose that all acute heart failure syndromes may be understood in terms of a relative fall in left ventricular stroke volume. The initial compensatory mechanism is frequently a tachycardia often resulting in a near normal cardiac output. In more severe forms a fall in cardiac output causes hypotension or cardiogenic shock. In chronic heart failure the stroke volume and cardiac output is returned to normal predominantly through ventricular remodeling or dilatation. Ejection fraction is simply the ratio of stroke volume and end-diastolic volume. The resting stroke volume is predetermined by the tissue's needs; therefore, if the ejection fraction changes, the end-diastolic volume must change in a reciprocal manner.
The potential role of the right heart in influencing the presentation of left heart disease is examined. We propose that acute pulmonary edema occurs when the right ventricular stroke volume exceeds left ventricular stroke volume leading to fluid accumulation in the alveoli. The possible role of the right heart in determining pulmonary hypertension and raised filling pressures in left-sided heart disease are discussed. Different clinical scenarios are presented to help clarify these proposed mechanisms and the clinical implications of these theories are discussed. Finally an alternative definition of heart failure is proposed.
Hypertensive heart disease and heart failure with normal left ventricular ejection fraction. Role of conventional and advanced echocardiography in the assessment of left ventricular dysfunction
2012, Journal of Cardiovascular Echography
La cardiopatia ipertensiva si manifesta con adattamenti strutturali e funzionali del miocardio che conducono, specie nelle donne di età >65 anni, verso l’insufficienza cardiaca prevalentemente di tipo diastolico.
La frazione di eiezione ventricolare sinistra (FE), considerata lo specchio effettivo della funzione sistolica, rappresenta invece un indicatore meno strettamente correlato a tale complesso rimodellamento, responsabile della molteplicità degli aspetti clinici. Soprattutto, non appare corretto affidare al solo valore del 50% di FE il significato discriminante tra funzione conservata e non conservata. Considerazioni critiche di tipo anatomico e funzionale sulla struttura dei ventricoli, sul loro modo di contrarsi e rilasciarsi, supportano la necessità di riconsiderare l’eccessiva valorizzazione di tale parametro.
La moderna ecocardiografia, con il Doppler tessutale e con lo speckle tracking, può fornire i mezzi per oggettivare e quantificare questa revisione.
Hypertensive heart disease is manifested by structural and functional adaptations of the myocardium that lead to heart failure, mainly diastolic, especially in women older than 65 years.
The ejection fraction of the left ventricle, which is considered an image of systolic function, represents instead an indicator less closely related to the complex ventricular remodeling, responsible for the variety of clinical aspects of hypertensive heart disease. Above all, it seems to be incorrect that the boundary between function “preserved” or “not preserved” is reflected only in the value of the ejection fraction of 50%. Anatomical and functional considerations of the structure of the ventricles and of the way in which they contract and release, suggest a need to reconsider the excessive value that is currently ascribed to this parameter.
Modern echocardiography with tissue Doppler and speckle tracking, may provide the means to objectively evaluate and quantify this new point of view.

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Diastolic Heart Failure: Definitions and Terminology

Section snippets

Comparison Between SHF and DHF

Acknowledgments

J. Am. Coll. Cardiol.

J. Am. Coll. Cardiol.

Lancet

J. Am. Cardiol.

J. Card. Fail.

Lancet

J. Card. Fail.

J. Am. Coll. Cardiol.

Am. J. Cardiol.

J. Am. Coll. Cardiol.

Am. J. Cardiol.

J. Card. Fail.

New concepts in diastolic dysfunction and diastolic heart failure: Part I. Diagnosis, prognosis, measurements of diastolic function

Circulation

Left ventricular diastolic dysfunction and diastolic heart failure

Annu. Rev. Med.

Burden of systolic and diastolic ventricular dysfunction in the community. Appreciating the scope of the heart failure epidemic

JAMA

How to diagnose diastolic heart failure

Eur. Heart. J.

Defining diastolic heart failure. A call for standardized diagnostic criteria

Circulation

The pathogenesis of acute pulmonary edema associated with hypertension

N. Engl. J. Med.

Heart failure with a normal ejection fraction. Is measurement of diastolic function necessary to make the diagnosis of diastolic heart failure?

Circulation