New Concepts in Diastolic Dysfunction and Diastolic Heart Failure: Part I

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Abstract
There is growing recognition that congestive heart failure (CHF) caused by a predominant abnormality in diastolic function (ie, diastolic heart failure) is both common and causes significant morbidity and mortality. However, there is continued controversy surrounding the definition of diastolic dysfunction and the diagnostic criteria for diastolic heart failure. As a result, clinical therapeutic trials have been slow to develop and difficult to design. Fortunately, these controversies are yielding to an emerging consensus. Recent clinical studies have provided sufficient data to develop standardized diagnostic criteria to define diastolic heart failure.1–4⇓⇓⇓ Experimental studies have provided increased insight into the mechanisms that cause diastolic heart failure.5–22⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓ Together, these clinical and experimental studies are being used to design targeted clinical trials to test effective treatments for diastolic heart failure. The purpose of this 2-part article is to provide a perspective on these issues, highlight new research, and introduce emerging ideas. Part 1 will focus on the criteria used to diagnose diastolic heart failure, the effects of diastolic heart failure on prognosis, and measurements used to assess diastolic function. Part 2 will describe the mechanisms that cause diastolic heart failure and discuss approaches to treatment. ### Differentiating Diastolic Dysfunction From Diastolic Heart Failure Heart failure is a clinical syndrome characterized by symptoms and signs of increased tissue/organ water and decreased tissue/organ perfusion. Standardized criteria to diagnose heart failure have been developed, perhaps the best validated of which come from the Framingham Study.23 Definition of the mechanisms that cause this clinical syndrome requires measurement of both systolic and diastolic function. When heart failure is accompanied by a predominant or isolated abnormality in diastolic function, this clinical syndrome is called diastolic heart failure. Diastolic dysfunction refers to a condition in which …