From the Guidelines
No, diastolic dysfunction is not the same as diastolic heart failure, though they are related conditions. Diastolic dysfunction refers to abnormal cardiac relaxation, filling, or diastolic stiffness that can be detected on diagnostic tests, but may not cause symptoms 1. Diastolic heart failure, also called heart failure with preserved ejection fraction (HFpEF), occurs when diastolic dysfunction progresses to the point where it causes clinical symptoms of heart failure despite normal or near-normal ejection fraction.
Key Differences
- Diastolic dysfunction is an underlying mechanical problem that can be asymptomatic, while diastolic heart failure represents the clinical syndrome that develops when the dysfunction becomes severe enough to cause symptoms like shortness of breath, fatigue, and fluid retention.
- Many patients have diastolic dysfunction without ever developing heart failure, particularly those with mild dysfunction 1.
- The progression from dysfunction to failure typically involves increasing left ventricular stiffness, elevated filling pressures, and eventually pulmonary congestion and symptoms.
Management
- Management differs between the two conditions, with asymptomatic dysfunction often requiring only risk factor control, while diastolic heart failure typically needs more aggressive treatment with diuretics, blood pressure management, and other heart failure therapies 1.
- The diagnosis of diastolic HF is generally based on the finding of typical symptoms and signs of HF in a patient who is shown to have a normal left ventricular ejection fraction and no valvular abnormalities on echocardiography 1.
- In the absence of controlled clinical trials, the management of patients with diastolic dysfunction is frequently determined by a set of therapeutic principles, including control of blood pressure, control of tachycardia, reduction in central blood volume, and alleviation of myocardial ischemia 1.
From the Research
Definition and Diagnosis
- Diastolic dysfunction and diastolic heart failure are related but not exactly the same thing 2, 3, 4, 5, 6.
- Diastolic heart failure is characterized by the symptoms and signs of heart failure, a preserved ejection fraction, and abnormal left ventricular diastolic function caused by a decreased left ventricular compliance and relaxation 3.
- Diastolic dysfunction refers to the abnormality in the diastolic function of the heart, which can be a precursor to diastolic heart failure 5.
Key Differences
- Diastolic dysfunction can exist alone or in combination with systolic dysfunction, while diastolic heart failure is a clinical syndrome that requires the presence of signs or symptoms of heart failure, normal or mildly abnormal systolic left ventricular function, and evidence of diastolic left ventricular dysfunction 4, 6.
- The diagnosis of diastolic heart failure requires a combination of clinical evaluation, echocardiography, and other diagnostic tests to assess left ventricular function and diastolic function 6.
Clinical Implications
- Diastolic heart failure is an important clinical disorder that is often underdiagnosed and undertreated 3, 5.
- The prognosis of diastolic heart failure is usually better than for systolic dysfunction, but morbidity can be substantial 5.
- Early recognition and appropriate therapy of diastolic dysfunction are crucial to prevent further progression to diastolic heart failure and death 5.
Diagnostic Criteria
- The diagnosis of diastolic heart failure requires the presence of signs or symptoms of heart failure, normal or mildly abnormal systolic left ventricular function, and evidence of diastolic left ventricular dysfunction 6.
- Diagnostic evidence of diastolic left ventricular dysfunction can be obtained invasively or non-invasively using techniques such as tissue Doppler, blood flow Doppler, and echocardiography 6.