Diastolic dysfunction: A review

Abstract

Heart failure has been traditionally regarded as due to abnormalities in the systolic or contractile function of the heart. However, up to 30-40% of patients with congestive heart failure have normal systolic contraction with the majority of these patients having abnormal diastolic function as the prime underlying disorder. The pathophysiology of diastolic dysfunction includes the presence of inappropriate tachycardia, abnormal left ventricular relaxation and decreased compliance. However, the clinical presentation and outcome of patients with congestive heart failure, secondary to diastolic dysfunction, can in fact be identical to those with systolic dysfunction, making differentiation between the two conditions very difficult. Investigations for diastolic dysfunction include echocardiography, radionuclide studies and cardiac catherisation. The therapeutic management of this condition is difficult as there are few large-scale trials investigating the benefits of treating diastolic dysfunction, although the use of bradycardiac, remodelling and lusitropic drugs have been suggested.