Elsevier

Journal of Cardiac Failure

Volume 13, Issue 7, September 2007, Pages 569-576
Journal of Cardiac Failure

Review Article
Systolic and Diastolic Heart Failure: Differences and Similarities

https://doi.org/10.1016/j.cardfail.2007.04.006Get rights and content

Abstract

Background

Diastolic heart failure (DHF) and systolic heart failure (SHF) are 2 clinical subsets of the syndrome of chronic heart failure that are most commonly encountered in clinical practice.

Methods and Results

The clinically overt DHF and SHF appear to be 2 separate syndromes with distinctive morphologic and functional changes although signs, symptoms, and prognosis are very similar. In DHF, the left ventricle is not dilated and the ejection fraction is preserved. In contrast in SHF, it is dilated and the ejection fraction is reduced. The neurohormonal abnormalities in DHF and SHF appear to be similar. The stimuli and the signals that ultimately produce these 2 different phenotypes of chronic heart failure remain, presently, largely unknown.

Conclusions

Although there has been considerable progress in the management of SHF, the management of DHF remains mostly empirical because of lack of knowledge of the molecular and biochemical mechanisms which produce myocardial structural and functional changes in this syndrome. Further research and investigations are urgently required.

Section snippets

Definitions and Diagnosis

In the Webster Dictionary diastole is defined as “the dilatation of the heart with blood: opposed to systole, or contraction.” Conventionally, the closure of the aortic valve is regarded to indicate the onset of diastole as it indicates the onset of ventricular relaxation phase.3 Because left ventricular ejection influences relaxation and the rapid filling, it has been suggested that these phases should be considered phases of systole.4 The most commonly accepted view, however, is that the

Systolic and Diastolic Dysfunction and Clinical Heart Failure

Systolic dysfunction from impaired contractile or pump function and diastolic dysfunction from impaired ventricular relaxation, compliance or filling are not always associated with clinical heart failure characterized by signs and symptoms of low cardiac output or of congestion. Furthermore, in SHF, diastolic dysfunction as assessed by changes in the ventricular filling features is common, particularly in advanced heart failure. In diastolic heart failure, left ventricular systolic performance,

Diagnosis

Based on the proposed definitions, it appears that for establishing the diagnosis of DHF or SHF, it is only necessary to measure left ventricular ejection fraction after confirming the presence of heart failure. If ejection fraction is preserved it is DHF, and if reduced it is SHF. It is highly desirable to establish the normal range of ejection fraction for any technique employed, preferably under similar loading conditions. It should be appreciated that signs and symptoms, radiologic and

Conclusion

Established clinical systolic and diastolic heart failure appear to be 2 distinct syndromes of chronic heart failure. The myocardial structural and primary functional derangements are distinctive in these 2 syndromes, although hemodynamic consequences, clinical presentations, signs and symptoms, and prognosis are similar. The neurohormonal abnormalities are also similar in both of these syndromes. Although there have been considerable advances in the management of systolic heart failure, the

Acknowledgment

The authors are grateful to Marci Yellin for her invaluable assistance in preparing the manuscript.

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    This manuscript has been published, in part, in Cardiology Rounds, a publication of Brigham and Women's Hospital, December 2005, Volume 9, Issues 9 and 10.

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