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Diabetes and prognosis: are systolic and diastolic heart failure different?
  1. Masoor Kamalesh
  1. Dr M Kamalesh, Indiana University, 1481 West 10th Street, Indianapolis 46202, USA; mkamales{at}iupui.edu

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SYSTOLIC VERSUS DIASTOLIC FAILURE

Multiple studies across countries have now shown that the long-term prognosis of diastolic heart failure is not very different from that of systolic heart failure.13 If that is the case then why bother differentiating between the two types of heart failure? The answer is because the treatment options differ greatly between the two conditions. Whereas treatment (drug and device) is well characterised for systolic dysfunction,4 there are precious few data and options available for treating diastolic dysfunction.4 While ejection fractions and left ventricular cavity size differ between the two forms of heart failure, signs and symptoms and neurohumoral abnormalities are similar between the two. These have been elegantly summarised recently by Chatterjee and Massie5 (table 1). It has even been proposed that these two forms of heart failure may be different phenotypes of the same pathophysiological basis.6 The stimuli responsible for these phenotypic differences are largely unknown.57

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Table 1 The two forms of heart failure. Adapted from Chatterjee and Massie5 and Taylor et al24

EPIDEMIOLOGY

Despite advances in treatment for congestive heart failure (CHF), mortality remains 40–80% higher for diabetic subjects with CHF than for non-diabetic subjects.8 Diabetes prevalence is increasing world wide, with prevalence of diabetes among patients with CHF increasing at an even faster pace.9 A recent report based on a nationwide registry in the United States showed that 44% of patients with CHF have diabetes.10 Diabetes has a particularly pernicious effect among women for the development of CHF.11 While multiple mechanisms are responsible for development of CHF in diabetes, ischaemic heart disease and comorbidities such as obesity and hypertension play a major role. …

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