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Diastolic heart failure

BMJ 2003; 327 doi: (Published 20 November 2003) Cite this as: BMJ 2003;327:1181

This article has a correction. Please see:

  1. Ramachandran S Vasan, associate professor of medicine (
  1. Boston University School of Medicine, 715 Albany St, Boston, MA 02118 USA

    The condition exists and needs to be recognised, prevented, and treated

    Diastolic heart failure refers to the clinical syndrome of heart failure with a preserved left ventricular ejection fraction (0.50 or more) in the absence of major valve disease.1 About a third of patients with heart failure seen by clinicians have diastolic heart failure as defined above.2 A simple classification of heart failure into systolic versus diastolic is useful because the two conditions have a distinctive pathophysiology and different prognoses.

    Although diastolic heart failure is common in clinical practice worldwide,3 4 5 its existence has been questioned for several reasons. Firstly, investigators have questioned whether these patients truly have heart failure or if they actually have conditions such as obesity or pulmonary disease that can mimic heart failure.6 Doubts regarding diastolic heart failure are cast especially because the diagnosis of heart failure is partly a clinical one and prone to error. When the left ventricular ejection fraction is low the diagnosis of heart failure is seldom questioned—clinicians seem more willing to accept a diagnosis of systolic heart failure.w1 Fortunately the advent of biomarkers such plasma B-type natriuretic peptides should help confirm the presence of heart failure in patients with suspected diastolic heart failure.w2

    A second area of controversy is that while investigators may agree that some patients with heart failure do have a normal ejection fraction, they doubt if the underlying mechanism …

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