Review ArticleSystolic and Diastolic Heart Failure: Differences and Similarities
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.