Diastolic heart failure: predictors of mortality

Diastolic heart failure (HF) as defined by the symptoms and signs of HF, preserved ejection fraction and abnormal diastolic function is estimated to occur in half of all patients presenting with HF. Patients with preserved ejection fraction are older and more often female. The underlying etiology of HF differs, with hypertension being more common in patients with preserved ejection fraction and ischemic heart disease predominant among those with reduced ejection fraction. Diastolic HF is associated with high mortality comparable with that of HF with depressed ejection fraction with a five year survival rate after a first episode of 43% and a higher excess mortality compared with the general population. Despite significant disease burden, clinical and biological prognostic factors in diastolic HF remain poorly understood. There is limited data from well designed studies regarding the effective treatment strategies for this group of patients. The purpose of this review is to summarize the mortality data and predictors of mortality in patients with diastolic HF for better understanding of the prognosis. In patients with diastolic HF older age, male gender, non-Caucasian ethnicity, history of coronary artery disease and atrial fibrillation are associated with poor prognosis. Anemia and B-type natriuretic peptide are significant laboratory variable that predict mortality. Two dimensional echocardiography and tissue Doppler imaging measurements including left ventricular ejection fraction, E/Ea ratio ≥ 15, restrictive transmiral filling (deceleration time £ 140 ms) and Em < 3.5 cm/s are predictors of adverse outcomes in diastolic HF patients.