Heart failure: clinical implications of systolic and diastolic dysfunction

Morbidity and mortality from congestive heart failure (CHF) remain high for older patients with systolic or diastolic dysfunction. These two disease processes differ in clinical manifestations, physical findings, treatment options, and prognosis. No one physical findings is diagnostic, which underlines the importance of assessing LV function with Doppler echocardiography. Diastolic dysfunction has been shown to increase with age, although most data demonstrating effective medical therapy for CHF applies to patients with systolic dysfunction. The treatment of older patients with preserved systolic function and CHF is therefore difficult, due to incomplete understanding of diastolic dysfunction and limited data about specific drug therapies.