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Diastolic heart failure. Paroxysmal or chronic?
Prithwish Banerjee1, Andrew L Clark, Nikolay Nikitin
1Department of Cardiology, University of Hull, Castle Hill Hospital, Kingston upon Hull HU16 5JQ, UK. pbanerjee@ukonline.co.uk
European Journal of Heart Failure
|June 9, 2004
Summary
Diastolic heart failure (DHF) may be less common than believed, with many cases potentially misdiagnosed. Factors like referral bias and other conditions can mimic DHF symptoms in ambulatory patients.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Heart failure with preserved systolic function (HFpEF) is often equated with diastolic heart failure (DHF).
- Epidemiological data suggests DHF comprises 30-50% of heart failure cases, yet clinicians observe more systolic dysfunction in outpatients.
Purpose of the Study:
- To investigate the discrepancy between reported prevalence of DHF and clinical observations in ambulatory heart failure patients.
- To explore potential reasons for the overestimation of DHF prevalence.
Main Methods:
- Review of diagnostic criteria and referral patterns for heart failure.
- Analysis of factors contributing to misdiagnosis of DHF in ambulatory settings.
- Consideration of alternative diagnoses and presentation patterns of diastolic dysfunction.
Main Results:
- Referral bias and inconsistent diagnostic thresholds may inflate DHF prevalence estimates.
- HFpEF is a heterogeneous condition, including subtle systolic dysfunction, pulmonary disease, obesity, and aging effects, not just true DHF.
- Symptoms attributed to DHF may stem from normal aging or other comorbidities.
Conclusions:
- True DHF might be significantly less prevalent than suggested by current epidemiological data.
- Paroxysmal diastolic dysfunction, presenting acutely, may be misattributed or overlooked in chronic outpatient settings.
- Re-evaluation of diagnostic criteria and consideration of alternative pathologies are crucial for accurate heart failure classification.