(Circulation. 2000;101:2020.)
© 2000 American Heart Association, Inc.
Editorial |
Defining Diastolic Dysfunction
From the UCSF Medical Center, University of California, San Francisco.
Correspondence to William Grossman, MD, Meyer Friedman Distinguished Professor of Medicine, University of California, San Francisco, Chief, Cardiology Division, UCSF Medical Center, 505 Parnassus Ave, Box 0124, San Francisco, CA 94143-0124. E-mail grossman@medicine.ucsf.edu
Key Words: Editorials • diastole • heart failure
The human
intellect has an almost irresistible urge to categorize and simplify.
Thus, over the years, heart failure has been classified as forward or
backward, right or left, compensated or decompensated. These
distinctions, which were made primarily on the basis of data obtained
from the history and physical examination, provided a conceptual
framework for thinking about heart failure and for rationalizing
therapeutic decisions (eg, digitalis to increase cardiac output in
"forward" failure). As information routinely available to the
clinician has been extended from the history and physical examination
to now include precise, noninvasive characterization of
ventricular volumes and aortic flow, it has been
increasingly recognized that the pathophysiology of heart failure
cannot be assessed adequately by the older classifications. For
example, it is now appreciated that "backward" heart failure with
elevated ventricular filling pressures and consequent
pulmonary or peripheral edema can result from
either systolic or diastolic
ventricular dysfunction. In fact, epidemiological and
case-control studies of individuals presenting with clinical heart
failure have estimated that 40% to 50% of such patients have normal
systolic function and presumed diastolic heart
failure.1 2 3 4 For example, Senni et al,1 from
the Mayo Clinic, reported that 43% of patients with clinical
congestive heart failure and adequate echocardiographic
assessment of ejection fraction show normal/preserved left
ventricular function. Although the prognosis of patients
with heart failure and preserved systolic function has
generally been regarded as intermediate between normal subjects and
patients whose heart failure is associated with depressed
systolic function, the recent Mayo study1 calls
this into
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