Diastolic heart failure: diagnosis and therapy

This article focuses on the recent findings in the diagnosis and treatment of diastolic heart failure (DHF) or heart failure with preserved ejection fraction.

DHF has become the most common form of heart failure in the population. Although diastolic dysfunction still plays a central role, it is now understood that DHF is a very complex clinical entity with heterogeneous pathophysiology and significant contribution from extracardiac comorbidities. Alterations in ventricular-arterial coupling play a significant role in the impaired hemodynamic response to exercise seen in these patients. The absence of diastolic dysfunction at rest does not exclude the diagnosis of DHF. There has been little to no progress made in identifying evidence-based, effective, and specific treatments for patients with DHF. This may be because of the pathophysiological heterogeneity, incomplete understanding of DHF, and heterogeneity of patients included in clinical trials with variable inclusion criteria.

The understanding of the phenotypic heterogeneity and multifactorial pathophysiology of DHF may lead to novel therapeutic targets in the future. Currently, the key to the treatment of DHF is aggressive management of contributing factors.