Assessment of Left Ventricular Diastolic Function and Recognition of Diastolic Heart Failure

Abstract

Left ventricular (LV) diastolic dysfunction, as occurs in patients with hypertension, diabetes mellitus, and/or aging, carries a substantial risk of the subsequent development of heart failure and reduced survival, even when it is asymptomatic or “preclinical.”1–4 Diastolic dysfunction is defined as functional abnormalities that exist during LV relaxation and filling. When such abnormalities cause or contribute to the clinical syndrome of heart failure with a normal LV ejection fraction, it is appropriate to describe the condition as diastolic heart failure. This diagnosis carries a mortality rate that is similar to that seen in systolic failure, approaching 15% per year in patients older than 65 years.5,6 Over the past 20 years, the survival of patients with systolic heart failure has improved, whereas the prognosis of diastolic heart failure has not changed.5 Diagnostic echocardiographic and Doppler techniques have improved,7 and criteria for the diagnosis of diastolic heart failure have been developed,8,9 but the evolution of therapeutic strategies has not kept pace with this growing public health problem. Improved therapy will depend on basic research directed at mechanisms of disease, coupled with clinical investigations directed at diagnosis and therapy. Article p 637 The article published by Kasner et al10 in this issue of Circulation consists of an exhaustive evaluation of invasive hemodynamic and noninvasive conventional and tissue Doppler echocardiographic parameters to search for the optimal method(s) for the evaluation of LV diastolic function. They studied 43 patients with definite and reliable evidence of diastolic dysfunction obtained during cardiac catheterization. The patients exhibited exercise intolerance, all were in New York Heart Association functional class II or III, and the level of the N-terminal pro B-type natriuretic peptide was elevated. The authors do not mention the physical examination, but presumably, the patients had been treated and signs of congestion …