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Heart Failure
Novel strategies in diastolic heart failure
  1. Walter J Paulus
  1. Correspondence to Professor Dr Walter J Paulus, Department of Physiology, VU University Medical Center Amsterdam, Van der Boechorststraat 7 1081 BT Amsterdam, The Netherlands; wj.paulus{at}vumc.nl

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The diagnosis of diastolic heart failure (DHF) is based on the presence of a triad consisting of signs or symptoms of congestive heart failure, a normal left ventricular (LV) systolic function, and evidence of diastolic LV dysfunction.1 As diastolic LV dysfunction is not unique to DHF but also occurs in patients with heart failure and reduced LV systolic function (ie, systolic heart failure), DHF is often referred to as heart failure with normal LV ejection fraction (EF) (HFNEF)w1 or heart failure with preserved LVEF (HFPEF).w2 DHF currently accounts for more than 50% of all heart failure cases in western societies.2 Although prognosis of patients with DHF was initially perceived as superior to patients with systolic heart failure (SHF), recent evidence shows prognosis to be equally poor in both conditions.2 Furthermore, whereas the prognosis of patients with SHF has improved over the last two decades as a result of modern heart failure treatment, the prognosis of patients with DHF has not improved notably over the same time period.2 This review will focus on current diagnostic and therapeutic strategies for DHF.

Diagnostic strategy

In contrast to SHF, which is easily diagnosed by signs or symptoms of fluid overload in the presence of a reduced LVEF (ie, LVEF <40%), the diagnosis of DHF is frequently challenging. Obvious signs of fluid overload such as lung crepitations, distended neck veins or pedal oedema are evident if the DHF patient presents in an emergency room with acute decompensated heart failure; however, the same physical signs are notoriously absent if the patient presents in an outpatient clinic with dyspnoea on exertion. Therefore, if the diagnosis of DHF is simply based on the presence of symptoms and a normal LVEF, physical deconditioning can erroneously be diagnosed as DHF. This high risk for a false …

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