Wednesday, May 06, 2009

Diastolic heart failure

This topic was recently reviewed in CMAJ.

First some definitions. Diastolic heart failure is the syndrome of heart failure due to impaired left ventricular filling in the context of a normal or near normal ejection fraction. Recently the term has been used interchangeably with “heart failure with preserved ejection fraction “(HFPEF). Such usage is not always appropriate, since some syndromes of HFPEF may be due to valvular dysfunction or systemic disease and need not involve diastolic dysfunction. (Personal observation: virtually all patients presenting to the hospital with acute decompensated heart failure have diastolic dysfunction and many have coexisting systolic dysfunction).

Key points from the article:

A vast body of evidence is available to guide treatment of systolic dysfunction. This is not true for diastolic dysfunction.

The evidence summary for pharmacologic therapies in the long term management of diastolic heart failure cited in the CMAJ review is shown here. Not impressive.

Guidelines for management, then, have been based largely on expert opinion and pathophysiologic rationale. They emphasize treatment of comorbidities and are summarized here. (Here’s an important JAMA paper emphasizing treatment of comorbidities in patients with HFPEF).

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