Defining diastolic heart failure: a call for standardized diagnostic criteria.

Abstract

Congestive heart failure (CHF) is a major public health problem in developed countries.1 2 3 It is a significant burden to patients, healthcare providers, and society.2 3 4 Several hospital-based reports have documented that a high proportion of patients with CHF have normal left ventricular (LV) systolic function,5 and 4 different epidemiological investigations further confirmed that nearly half of CHF subjects in the community have normal LV systolic function.6 7 8 9 This condition is commonly referred to as diastolic heart failure (DHF). Hospital readmission rates for patients with DHF are similar to those for patients with systolic heart failure (SHF),10 and it is estimated that DHF accounts for ≥25% of the total cost of CHF, which is estimated at $15 to $40 billion annually.4 11 A distinction between DHF and SHF is important because DHF is associated with better long-term survival5 and because these 2 forms of heart failure require different therapeutic approaches. Although the societal burden of DHF is high and its economic impact substantial, it is intriguing that most national and international guidelines either do not consider the condition12 13 or underscore that a paucity of information about it precludes any definitive therapeutic recommendations.14 Numerous clinical trials have documented the benefits of treatment for SHF; however, the optimal treatment for DHF has not yet been defined. The first step toward evaluating any potential treatment for DHF is to develop uniform criteria for its diagnosis. This task, however, is complicated by the pathophysiological heterogeneity of DHF11 and by the limitations of currently available noninvasive modalities for diagnosing LV diastolic dysfunction.5 Heart failure is defined as “a pathophysiological state in which an abnormality of cardiac function is responsible for failure of the heart to pump blood at a …