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 (1-3). If that is the case then why bother differentiating the two types of heart failure? The answer is because the treatment options differ greatly between the two conditions. While therapy (drug and device) is well characterized for systolic dysfunction (4), there are precious little 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 very similar between the two. These have been elegantly summarized recently by Chatterjee and Massie (5) (See Table). It has even been proposed that these two forms of heart failure may be different phenotypes of the same pathophysiologic basis (6). The stimuli responsible for these phenotypic differences is largely unknown (5,6,7).
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