Prevalence, clinical features and prognosis of diastolic heart failure: an epidemiologic perspective

Framingham Heart Study, Massachusetts 01701, USA.

Numerous reports suggest that about one-third of patients with congestive heart failure do not have any abnormality of left ventricular systolic function. These patients presumably have heart failure on the basis of ventricular diastolic dysfunction. Our objective was to develop a comprehensive overview of published reports of the prevalence, clinical features and prognosis of diastolic heart failure and to offer recommendations for future studies. Thirty-one studies of patients with congestive heart failure with normal left ventricular systolic function were published in the time period from January 1970 through March 1995. These studies were identified with the use of computer-based searches in relevant data bases. Among patients with congestive heart failure, the prevalence of normal ventricular systolic performance in the published reports varies widely from 13% to 74%; the reported annual mortality rate also varies from 1.3% to 17.5%. The criteria for congestive heart failure, its chronicity and the age of the study sample affect the reported prevalence and prognosis of the disorder. The clinical signs and symptoms of diastolic heart failure are similar to those of patients with systolic heart failure, underscoring the need for evaluation of ventricular systolic function in patients with congestive heart failure. In the absence of any large-scale randomized clinical trial targeting these patients, the optimal treatment of diastolic heart failure is unclear. We conclude that the heterogeneity in previous studies of diastolic heart failure hinders the comparison of published reports. There is a need to conduct prospective, community-based investigations to better characterize the incidence, prevalence and natural history of diastolic heart failure. Randomized clinical trials are needed to determine optimal treatment strategies.

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				M.R Cowie, P Jourdain, A Maisel, U Dahlstrom, F Follath, R Isnard, A Luchner, T McDonagh, J Mair, M Nieminen, et al. Clinical applications of B-type natriuretic peptide (BNP) testing Eur. Heart J., October 1, 2003; 24(19): 1710 - 1718. [Abstract] [Full Text] [PDF]

				V. Sim, D. Hampton, C. Phillips, S.-N. Lo, S. Vasishta, J. Davies, and M. Penney The use of brain natriuretic peptide as a screening test for left ventricular systolic dysfunction-- cost-effectiveness in relation to open access echocardiography Fam. Pract., October 1, 2003; 20(5): 570 - 574. [Abstract] [Full Text] [PDF]

				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]

				J. P. Curtis, S. I. Sokol, Y. Wang, S. S. Rathore, D. T. Ko, F. Jadbabaie, E. L. Portnay, S. J. Marshalko, M. J. Radford, and H. M. Krumholz The association of left ventricular ejection fraction, mortality, and cause of death in stable outpatients with heart failure J. Am. Coll. Cardiol., August 20, 2003; 42(4): 736 - 742. [Abstract] [Full Text] [PDF]

				P. A MacCarthy, M. T Kearney, J. Nolan, A. J Lee, R. J Prescott, A. M Shah, W P. Brooksby, and K. A A Fox Prognosis in heart failure with preserved left ventricular systolic function: prospective cohort study BMJ, July 10, 2003; 327(7406): 78 - 79. [Full Text] [PDF]

				A. M. Richards, M. G. Nicholls, E. A. Espiner, J. G. Lainchbury, R. W. Troughton, J. Elliott, C. Frampton, J. Turner, I. G. Crozier, and T. G. Yandle B-Type Natriuretic Peptides and Ejection Fraction for Prognosis After Myocardial Infarction Circulation, June 10, 2003; 107(22): 2786 - 2792. [Abstract] [Full Text] [PDF]

				T. J. Wang, D. Levy, E. J. Benjamin, and R. S. Vasan The Epidemiology of "Asymptomatic" Left Ventricular Systolic Dysfunction: Implications for Screening Ann Intern Med, June 3, 2003; 138(11): 907 - 916. [Abstract] [Full Text] [PDF]

				H. Ruskoaho Cardiac Hormones as Diagnostic Tools in Heart Failure Endocr. Rev., June 1, 2003; 24(3): 341 - 356. [Abstract] [Full Text] [PDF]

				J. McMurray, J. Ostergren, M. Pfeffer, K. Swedberg, C. Granger, S. Yusuf, P. Held, E. Michelson, B. Olofsson, and On behalf of the CHARM committees and investigator Clinical features and contemporary management of patients with low and preserved ejection fraction heart failure: baseline characteristics of patients in the Candesartan in Heart failure--Assessment of Reduction in Mortality and morbidity (CHARM) programme Eur J Heart Fail, June 1, 2003; 5(3): 261 - 270. [Abstract] [Full Text] [PDF]

				L. W. Miller Patient selection for the use of ventricular assist devices as a bridge to transplantation Ann. Thorac. Surg., June 1, 2003; 75(90060): S66 - 71. [Abstract] [Full Text] [PDF]

				G. L. Smith, F. A. Masoudi, V. Vaccarino, M. J. Radford, and H. M. Krumholz Outcomes in heart failure patients with preserved ejection fraction: Mortality, readmission, and functional decline J. Am. Coll. Cardiol., May 7, 2003; 41(9): 1510 - 1518. [Abstract] [Full Text] [PDF]

				D. Tallarico, V. Rizzo, F. di Maio, F. Petretto, G. Bianco, G. Placanica, M. Marziali, V. Paravati, N. Gueli, F. Meloni, et al. Myocardial Cytoprotection by Trimetazidine Against Anthracycline-Induced Cardiotoxicity in Anticancer Chemotherapy Angiology, March 1, 2003; 54(2): 219 - 227. [Abstract] [PDF]

				Y. Sakata, K. Yamamoto, T. Mano, N. Nishikawa, J. Yoshida, T. Miwa, M. Hori, and T. Masuyama Temocapril prevents transition to diastolic heart failure in rats even if initiated after appearance of LV hypertrophy and diastolic dysfunction Cardiovasc Res, March 1, 2003; 57(3): 757 - 765. [Abstract] [Full Text] [PDF]