[Diastolic heart failure. Signs and diagnosis]

A WELL-RECOGNIZED ENTITY: Diastolic heart failure is an increasingly common diagnosis. Signs may be misleading and positive etiological diagnosis remains difficult.

Fatigue, and most importantly dyspnea, are the cardinal signs of diastolic heart failure. Cor pulmonale is often the inaugural sign. The physical examination contributes little to diagnosis. The chest x-ray shows a small heart. Electrocardiographic anomalies are almost always found. A hemodynamic exploration of the right heart, the key diagnostic tool not always performed in routine work-ups, evidences increased filling pressure of the left ventricle. Doppler-echocardiography is used widely. It demonstrates preservation of the left ventricle function (normal ejection fraction) and visualizes the anatomic subtratum of the diastolic dysfunction, quantifying filling and relaxation disorders and allowing an indirect estimation of pulmonary pressures. In the future, it will be possible to assay atrial natriuretic peptide which will provide a most useful tool for the positive diagnosis of this type of heart failure.

The diagnosis of diastolic heart failure is complex, warranting rigorous, and critical, evaluation of left ventricular filling using noninvasive methods, particularly Doppler-echocardiography.