From the Guidelines
Systolic and diastolic heart failure are two distinct types of heart failure with different underlying mechanisms, with systolic heart failure characterized by a reduced ejection fraction (typically less than 40%) and diastolic heart failure characterized by a normal ejection fraction (typically above 50%) but impaired relaxation and filling of the heart. The main difference between systolic and diastolic heart failure lies in the heart's ability to contract and pump blood. Systolic heart failure, also known as heart failure with reduced ejection fraction (HFrEF), occurs when the heart's left ventricle cannot contract with enough force to pump sufficient blood throughout the body, resulting in a reduced ejection fraction [ 1 ]. In contrast, diastolic heart failure, or heart failure with preserved ejection fraction (HFpEF), involves the heart's inability to relax and fill properly during the diastolic phase, despite maintaining normal contraction strength [ 1 ].
Key Characteristics of Systolic and Diastolic Heart Failure
- Systolic heart failure:
- Reduced ejection fraction (typically less than 40%)
- Commonly results from conditions that damage the heart muscle, such as coronary artery disease, heart attacks, or cardiomyopathy
- Responds well to medications like ACE inhibitors, beta-blockers, and aldosterone antagonists that improve survival
- Diastolic heart failure:
- Normal ejection fraction (typically above 50%)
- Often associated with long-standing hypertension, aging, diabetes, or left ventricular hypertrophy
- Management focuses primarily on controlling symptoms and addressing underlying conditions like hypertension
Treatment Approaches
The treatment approaches for systolic and diastolic heart failure differ. Systolic heart failure responds well to medications that improve survival, whereas diastolic heart failure management focuses on controlling symptoms and addressing underlying conditions [ 1 ]. Both types share common symptoms, including shortness of breath, fatigue, and fluid retention, though their pathophysiology and treatment strategies remain distinct [ 1 ].
Importance of Accurate Diagnosis
Accurate diagnosis of systolic and diastolic heart failure is crucial, as it guides treatment decisions and affects patient outcomes [ 1 ]. The European Society of Cardiology (ESC) guidelines emphasize the importance of differentiating between HFrEF and HFpEF, as well as identifying patients with mid-range ejection fraction (HFmrEF) [ 1 ]. By understanding the differences between systolic and diastolic heart failure, healthcare providers can provide personalized care and improve patient outcomes.
From the FDA Drug Label
The provided drug labels do not directly compare or discuss the differences between systolic heart failure and diastolic (heart failure with preserved ejection fraction) heart failure.
The FDA drug label does not answer the question.
From the Research
Differences between Systolic and Diastolic Heart Failure
- Systolic heart failure (SHF) is characterized by a dilated left ventricle and reduced ejection fraction, whereas diastolic heart failure (DHF) is characterized by a non-dilated left ventricle and preserved ejection fraction 2, 3.
- Despite similarities in signs, symptoms, and prognosis, DHF and SHF appear to be two separate syndromes with distinctive morphologic and functional changes 2.
- Diastolic abnormalities are present in both DHF and SHF, and the severity of heart failure and its prognosis are closely related to the degree of diastolic filling abnormalities, regardless of ejection fraction 3.
Pathogenesis and Pathophysiology
- The pathogenesis and pathophysiology of diastolic and systolic heart failure have similarities and differences, with diastolic heart failure being referred to as heart failure with preserved ejection fraction (HFpEF) and systolic heart failure being referred to as heart failure with reduced ejection fraction (HFrEF) 4.
- Diastolic heart failure is a common condition worldwide, but its pathophysiology has not been sufficiently elucidated, making it challenging to establish treatment methods 4.
Prognosis and Treatment
- Differences exist in prognosis and treatment between diastolic and systolic heart failure, with diastolic heart failure being associated with significant morbidity, mortality, and cost 5.
- Diastolic heart failure may correlate better with prognosis for symptoms and survival than traditional indices of systolic function, and its presence has important therapeutic implications 6.
- The diagnosis of diastolic heart failure is clinical, and much of the treatment is based on current concepts of the pathophysiology, small clinical studies, and experience gained from treating patients with systolic heart failure 5.