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Circulation. 2000;101:2118-2121

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(Circulation. 2000;101:2118.)
© 2000 American Heart Association, Inc.


Current Perspective

Defining Diastolic Heart Failure

A Call for Standardized Diagnostic Criteria

Ramachandran S. Vasan, MD; Daniel Levy, MD

From the National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, Mass (R.S.V., D.L.); the Divisions of Cardiology and Clinical Epidemiology, Beth Israel Hospital, Boston, Mass (D.L.); the Department of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, Mass (R.S.V., D.L.); and the National Heart, Lung, and Blood Institute, Bethesda, Md (D.L.).

Correspondence to Ramachandran S. Vasan, MD, Framingham Heart Study, 5 Thurber Street, Framingham, MA 01702. E-mail vasan@fram.nhlbi.nih.gov


Key Words: heart failure • diastole • echocardiography • imaging • diagnosis


*    Introduction
 
Congestive heart failure (CHF) is a major public health problem in developed countries.1 2 3 It is a significant burden to patients, healthcare providers, and society.2 3 4

Several hospital-based reports have documented that a high proportion of patients with CHF have normal left ventricular (LV) systolic function,5 and 4 different epidemiological investigations further confirmed that nearly half of CHF subjects in the community have normal LV systolic function.6 7 8 9 This condition is commonly referred to as diastolic heart failure (DHF). Hospital readmission rates for patients with DHF are similar to those for patients with systolic heart failure (SHF),10 and it is estimated that DHF accounts for >=25% of the total cost of CHF, which is estimated at $15 to $40 billion annually.4 11 A distinction between DHF and SHF is important because DHF is associated with better long-term survival5 and because these 2 forms of heart failure require different therapeutic approaches.

Although the societal burden of DHF is high and its economic impact substantial, it is intriguing that most national and international guidelines either do not consider the condition12 13 or underscore that a paucity of information about it precludes any definitive therapeutic recommendations.14 Numerous clinical trials have documented the benefits of treatment for SHF; however, the optimal treatment for DHF has not yet been defined. The first step toward evaluating any potential treatment for DHF is to develop uniform criteria for its diagnosis. This task, however, is complicated by the pathophysiological heterogeneity of DHF11 and by the limitations of currently available noninvasive modalities for diagnosing . . . [Full Text of this Article]




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HeartHome page
M C Petrie, K Hogg, L Caruana, and J J V McMurray
Poor concordance of commonly used echocardiographic measures of left ventricular diastolic function in patients with suspected heart failure but preserved systolic function: is there a reliable echocardiographic measure of diastolic dysfunction?
Heart, May 1, 2004; 90(5): 511 - 517.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
M. Klapholz, M. Maurer, A. M. Lowe, F. Messineo, J. S. Meisner, J. Mitchell, J. Kalman, R. A. Phillips, R. Steingart, E. J. Brown Jr, et al.
Hospitalization for heart failure in the presence of a normal left ventricular ejection fraction: Results of the New York heart failure registry
J. Am. Coll. Cardiol., April 21, 2004; 43(8): 1432 - 1438.
[Abstract] [Full Text] [PDF]


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Eur J Heart FailHome page
U. Dahlstrom
Can natriuretic peptides be used for the diagnosis of diastolic heart failure?
Eur J Heart Fail, March 15, 2004; 6(3): 281 - 287.
[Abstract] [Full Text] [PDF]


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Eur J Heart FailHome page
M. D. Thomas, K. F. Fox, A. J.S. Coats, and G. C. Sutton
The epidemiological enigma of heart failure with preserved systolic function
Eur J Heart Fail, March 1, 2004; 6(2): 125 - 136.
[Abstract] [Full Text] [PDF]


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Journal of Renin-Angiotensin-Aldosterone SystemHome page
M. Tendera
The epidemiology of heart failure
Journal of Renin-Angiotensin-Aldosterone System, March 1, 2004; 5(1_suppl): S2 - S6.
[Abstract] [PDF]


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J Am Coll CardiolHome page
K. Hogg, K. Swedberg, and J. McMurray
Heart failure with preserved left ventricular systolic function: epidemiology, clinical characteristics, and prognosis
J. Am. Coll. Cardiol., February 4, 2004; 43(3): 317 - 327.
[Abstract] [Full Text] [PDF]


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ChestHome page
B. K. Gehlbach and E. Geppert
The Pulmonary Manifestations of Left Heart Failure
Chest, February 1, 2004; 125(2): 669 - 682.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
H. Yamaguchi, J. Yoshida, K. Yamamoto, Y. Sakata, T. Mano, N. Akehi, M. Hori, Y.-J. Lim, M. Mishima, and T. Masuyama
Elevation of plasma brain natriuretic peptide is a hallmark of diastolic heart failure independent of ventricular hypertrophy
J. Am. Coll. Cardiol., January 7, 2004; 43(1): 55 - 60.
[Abstract] [Full Text] [PDF]


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BMJHome page
R. S Vasan
Diastolic heart failure
BMJ, November 22, 2003; 327(7425): 1181 - 1182.
[Full Text] [PDF]


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HeartHome page
J E Sanderson
Diastolic heart failure: fact or fiction?
Heart, November 1, 2003; 89(11): 1281 - 1282.
[Full Text] [PDF]


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HeartHome page
S R Ommen and R A Nishimura
A clinical approach to the assessment of left ventricular diastolic function by Doppler echocardiography: update 2003
Heart, November 1, 2003; 89(90003): iii18 - 23.
[Full Text] [PDF]


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Eur J Heart FailHome page
S. Nodari, M. Metra, and L. D. Cas
{beta}-Blocker treatment of patients with diastolic heart failure and arterial hypertension. A prospective, randomized, comparison of the long-term effects of atenolol vs. nebivolol
Eur J Heart Fail, October 1, 2003; 5(5): 621 - 627.
[Abstract] [Full Text] [PDF]


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J. Thorac. Cardiovasc. Surg.Home page
H. Bolooki, E. DeMarchena, S. M. Mallon, K. Katariya, M. Barron, H. M. Bolooki, R. J. Thurer, S. Novak, and R. C. Duncan
Factors affecting late survival after surgical remodeling of left ventricular aneurysms
J. Thorac. Cardiovasc. Surg., August 1, 2003; 126(2): 374 - 385.
[Abstract] [Full Text] [PDF]


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NEJMHome page
M. Jessup and S. Brozena
Heart Failure
N. Engl. J. Med., May 15, 2003; 348(20): 2007 - 2018.
[Full Text] [PDF]


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J Am Coll CardiolHome page
M. R. Zile
Heart failure with preserved ejection fraction: is this diastolic heart failure?
J. Am. Coll. Cardiol., May 7, 2003; 41(9): 1519 - 1522.
[Full Text] [PDF]


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JAMAHome page
R. S. Vasan, A. Beiser, R. B. D'Agostino, D. Levy, J. Selhub, P. F. Jacques, I. H. Rosenberg, and P. W. F. Wilson
Plasma Homocysteine and Risk for Congestive Heart Failure in Adults Without Prior Myocardial Infarction
JAMA, March 12, 2003; 289(10): 1251 - 1257.
[Abstract] [Full Text] [PDF]


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CirculationHome page
B. G. Angeja and W. Grossman
Evaluation and Management of Diastolic Heart Failure
Circulation, February 11, 2003; 107(5): 659 - 663.
[Full Text] [PDF]


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CirculationHome page
M. Kawaguchi, I. Hay, B. Fetics, and D. A. Kass
Combined Ventricular Systolic and Arterial Stiffening in Patients With Heart Failure and Preserved Ejection Fraction: Implications for Systolic and Diastolic Reserve Limitations
Circulation, February 11, 2003; 107(5): 714 - 720.
[Abstract] [Full Text] [PDF]


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HeartHome page
D. G Gibson and D. P Francis
CLINICAL ASSESSMENT OF LEFT VENTRICULAR DIASTOLIC FUNCTION
Heart, February 1, 2003; 89(2): 231 - 238.
[Full Text] [PDF]


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CirculationHome page
E. G. Lakatta and D. Levy
Arterial and Cardiac Aging: Major Shareholders in Cardiovascular Disease Enterprises: Part II: The Aging Heart in Health: Links to Heart Disease
Circulation, January 21, 2003; 107(2): 346 - 354.
[Full Text] [PDF]


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J Am Coll CardiolHome page
M. Jessup
The less familiar face of heart failure
J. Am. Coll. Cardiol., January 15, 2003; 41(2): 224 - 226.
[Full Text] [PDF]


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JAMAHome page
D. W. Kitzman, W. C. Little, P. H. Brubaker, R. T. Anderson, W. G. Hundley, C. T. Marburger, B. Brosnihan, T. M. Morgan, and K. P. Stewart
Pathophysiological Characterization of Isolated Diastolic Heart Failure in Comparison to Systolic Heart Failure
JAMA, November 6, 2002; 288(17): 2144 - 2150.
[Abstract] [Full Text] [PDF]


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Vasc MedHome page
B. H Gray, J. W Olin, M. B. Childs, T. M Sullivan, and J M. Bacharach
Clinical benefit of renal artery angioplasty with stenting for the control of recurrent and refractory congestive heart failure
Vascular Medicine, November 1, 2002; 7(4): 275 - 279.
[Abstract] [PDF]


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ANN INTERN MEDHome page
J. S. Gottdiener, R. L. McClelland, R. Marshall, L. Shemanski, C. D. Furberg, D. W. Kitzman, M. Cushman, J. Polak, J. M. Gardin, B. J. Gersh, et al.
Outcome of Congestive Heart Failure in Elderly Persons: Influence of Left Ventricular Systolic Function: The Cardiovascular Health Study
Ann Intern Med, October 15, 2002; 137(8): 631 - 639.
[Abstract] [Full Text] [PDF]


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NEJMHome page
S. Kenchaiah, J. C. Evans, D. Levy, P. W.F. Wilson, E. J. Benjamin, M. G. Larson, W. B. Kannel, and R. S. Vasan
Obesity and the Risk of Heart Failure
N. Engl. J. Med., August 1, 2002; 347(5): 305 - 313.
[Abstract] [Full Text] [PDF]