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Diastolic heart failure: a separate disease or selection bias?

Gilles W De Keulenaer1, Dirk L Brutsaert

  • 1Department of Physiology, University of Antwerp, and Division of Cardiology, Middelheim Hospital, Antwerp, Belgium. gilles.dekeulenaer@ua.ac.be

Progress in Cardiovascular Diseases
|December 23, 2006
PubMed

Insights

Chronic heart failure (CHF) is not two separate conditions but a spectrum. Current research approaches, often biased, should be revised to view CHF as one disease influencing diverse phenotypes.

Area of Science:

  • Cardiology
  • Internal Medicine

Background:

  • Chronic heart failure (CHF) is traditionally classified into diastolic and systolic forms based on left ventricular ejection fraction (LVEF).
  • This binary classification has guided clinical trials and conceptual models of CHF for years.

Observation:

  • This review argues against the LVEF-based bimodal view of CHF.
  • The current understanding of CHF lacks a strong pathophysiological basis for this division.
  • Clinical trials for CHF have historically suffered from selection biases related to LVEF subgroups.

Findings:

  • CHF should be conceptualized as a single pathophysiological entity with a spectrum of phenotypes.
  • The traditional "diastolic" and "systolic" heart failure categories are not pathophysiologically distinct.
  • Existing conceptual models, like the vicious circle paradigm, become obsolete under this unified view.

Implications:

  • Future research should treat CHF as one disease, moving beyond LVEF-based selection biases.
  • Investigating how factors like sex, diabetes, and hypertension modify CHF phenotypes is crucial.
  • A unified approach will enable a more accurate understanding and treatment of heart failure diversity.

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