Diastolic dysfunction and diastolic heart failure: mechanisms and epidemiology

Studies have demonstrated that diastolic dysfunction is frequently present in asymptomatic community-based individuals, especially in the elderly with hypertension, coronary artery disease, and diabetes. The presence of diastolic dysfunction is a predictor for the development of heart failure (HF) and confers a higher risk of mortality. These findings have raised the question of whether treating preclinical diastolic dysfunction will be helpful in preventing or delaying the onset of clinical HF and mortality, as has been proven with treatment of asymptomatic left ventricular systolic dysfunction. In addition, in some individuals, diastolic dysfunction in the presence of a normal ejection fraction is associated with exercise intolerance as well as symptomatic clinical HF, referred to as diastolic HF. Patients with diastolic HF, who are more often elderly women, have a significant mortality and morbidity burden compared with age-matched controls. Studies that further our understanding of mechanisms underlying diastolic dysfunction and diastolic HF will provide potential new targets for development of effective therapies for these conditions.