[Prognosis of diastolic cardiac insufficiency]

The natural history and prognosis of diastolic cardiac failure are difficult to determine because of the large differences in the studies which have been performed in this field. The ten studies published to date concerning the prognosis have been performed on hospital populations and, consequently, only the most severe cases have been recruited. Moreover, the threshold values of indices of the ejection phase used to define systolic dysfunction vary from one study to another. A review of these papers provides a rather disconcerting appreciation of the annual mortality rate (from 1.3% to 17.5%). The differences in aetiology, age and threshold values of parameters of systolic function probably explain most of the variability observed. Taking unbiased studies alone in consideration, such as the Framingham study, the mean annual mortality of diastolic cardiac failure between 55 and 71 years, is 3 to 9%, much less than that observed with predominantly systolic dysfunction (15 to 20%). Other prospective studies, adjusting morbidity and mortality to age and other principal prognostic factors, are awaited.