Diastolic dysfunction: prevalence, mortality risk, and assessing severity to stratify risk

Much of the mortality and morbidity of left ventricula failure evolves from diastolic dysfunction, yet because diastolic dysfunction is in part defined by a normal ejection fraction, identifying this risk before the onset of overt heart failure requires understanding its causes, the echocardiographic measurements that define it, and how this data is used to assess its severity. Some physicians, particularly those trained over 20 years ago, are not yet able to identify diastolic dysfunction and quantify its severity. This is in part because the echocardiographic trends used to grade severity appear counterintuitive and in part because the echocardiographics ability to accurately measure left ventricular filling hemodynamics has evolved only over the past 2 decades. This article provides a practical review of the etiology, prevalence, and mortality of diastolic dysfunction and failure, and then characterizes how the pathophysiology of this disorder translates into measurements from 2D, pulsed-wave, and tissue Doppler echocardiography that can be confidently used to identify those insurance applicants at risk for imminent morbidity and mortality.