The diagnosis and treatment of diastolic heart failure

Heart failure with normal systolic function, or so-called diastolic heart failure, accounts for approximately one half of all heart failure cases. Diastolic dysfunction is also present in almost all patients with diminished systolic function. However, there are no generally agreed upon criteria for the diagnosis of diastolic heart failure, nor have guidelines been established for its treatment. Once a clinical diagnosis of heart failure has been made and normal systolic function has been documented, diastolic function may be assessed using various echo-Doppler derived parameters. These parameters can also be monitored during therapy, although treatment goals based on echo-Doppler findings have not been delineated. Acute treatment of diastolic heart failure should be directed at identifying and correcting precipitating causes, such as ischemia, volume overload, uncontrolled hypertension, or pericardial disease. Normal sinus rhythm at a physiologic rate should be maintained in order to optimize diastolic filling. Long-term therapy should be directed at controlling hypertension and ischemia, and at treating coexistent systolic dysfunction. Results from large clinical trials addressing therapy for diastolic heart failure are lacking; however, limited data indicate that diuretics, β blockers, angiotensin-converting enzyme inhibitors, calcium channel blockers, and possibly angiotensin-receptor blockers and digoxin all may provide symptomatic palliation in selected patients.