Diastolic heart failure: boundaries of term application

Abstract

Important changes regarding the understanding of the pathogenesis of chronic heart failure (CHF) marked the beginning of the millennium, and its first decade was called the decade of diastology. Even though numerous studies convincingly proved that deterioration of the left ventricular (LV) filling pressure often precedes impairment of its systolic function and a number of factors affect (especially at the onset) mainly the diastolic function without changing the conditions of blood ejection, modern classifications and approaches to CHF treatment are primarily based on the results of LV ejection fraction (EF) assessment.In recent years, diastolic heart failure (DHF) has been often overlooked and replaced by the ambiguous term “CHF with preserved EF”. However, sometimes authors use the term DHF extensively, since CHF based on myocardial insufficiency develops only via two mechanisms (systolic and / or diastolic dysfunction), and excluding one of the mechanisms allows to identify the underlying one. The term DHF can be used in clinical practice and cannot be replaced by the diagnosis of CHF with preserved EF. CHF with preserved EF is a broader concept which includes a full spectrum of cardiovascular diseases, complicated by the development of CHF without depression of the global LV contractility and requiring differentiated approaches to therapy. In addition, the results of repeated studies on LVEF in many patients may require reclassification of this CHF phenotype, which is established following the analysis of the baseline value of global LV contractility. We join M.R. Zile in the appeal to stop discriminating against the term “DHF” and present the boundaries of its correct application.