Clinical manifestations and diagnosis of diastolic heart failure

Official reprint from UpToDate®

www.uptodate.com ©2013 UpToDate®

Authors

Michael R Zile, MD

William H Gaasch, MD

Section Editor

Wilson S Colucci, MD

Deputy Editor

Susan B Yeon, MD, JD, FACC

Clinical manifestations and diagnosis of diastolic heart failure

Disclosures

All topics are updated as new evidence becomes available and our peer review process is complete.

Literature review current through: Aug 2013. | This topic last updated: Abr 3, 2013.

INTRODUCTION — Diastolic heart failure (DHF) is a clinical syndrome in which patients have symptoms and

signs of heart failure (HF), normal or near normal left ventricular (LV) ejection fraction (EF), normal or near normal

LV volume, and evidence of diastolic dysfunction (eg, abnormal pattern of LV filling and elevated filling

pressures) [1-3]. By contrast, systolic heart failure (SHF) is characterized by increased LV volume and reduced

EF. Among all patients with HF, as many as half have a normal or near normal LVEF [1,4-9]. This condition has

been termed "heart failure with normal ejection fraction" (HFNEF) or “heart failure with preserved ejection fraction”

(HF-PEF) [10]. However, this category (HF-NEF or HF-PEF) encompasses a mixed group of clinical syndromes

that includes DHF as well as other conditions such as valvular heart disease, pericardial disease, and right heart

failure (table 1 and algorithm 1) [11]. (See "Pathophysiology of diastolic heart failure", section on 'Terminology'.)

In patients with DHF, diastolic dysfunction is the dominant cause of the heart failure [1,12,13]. The etiology,

clinical manifestations, and diagnosis of patients with DHF will be reviewed here. Issues related to treatment,

prognosis, and pathophysiology are discussed separately. (See "Treatment and prognosis of diastolic heart

failure" and "Pathophysiology of diastolic heart failure" and "Cellular mechanisms of diastolic dysfunction".)

PREVALENCE AND DEMOGRAPHICS — The prevalence of heart failure with preserved ejection fraction (HFPEF)

and diastolic heart failure (DHF) increases with age [1,6,14]. This was illustrated in a review in which the

estimated prevalence of DHF among patients with HF was 15, 33, and 50 percent at ages <50, 50 to 70, and

>70 years, respectively [1].

A Mayo Clinic study examined all consecutive patients hospitalized with decompensated heart failure from 1987

through 2001 [15]. The proportion of patients with the diagnosis of HF-PEF increased over time and was

significantly higher among community patients than among referral patients (55 versus 45 percent).

HF-PEF is more common in women than men [16-19]. In a chart study of over 19,000 Medicare beneficiaries

hospitalized with the principal discharge diagnosis of HF, 35 percent had a normal EF [16]. Among patients with

normal EF, 79 percent were women, while among those with decreased EF, 49 percent were women. Data from

randomized