Working Group Report. How to diagnose diastolic heart failure

Diastolic heart failure has emerged over the last 10 years as a separate clinical entity. Diastolic heart failure accounts for approximately one third of all heart failure cases, especially in an elderly population, and its natural history, with an annual mortality rate of 8%, is more benign than other forms of heart failure with an annual mortality of 19%. Because of its rising incidence in ageing Western populations and because of its different prognosis, specific treatment options for patients suffering from diastolic heart failure are currently being tested in large randomized trials. A need has therefore grown to establish precise criteria for the diagnosis of diastolic heart failure. Such diagnostic criteria should: (1) reflect underlying pathophysiological mechanisms; (2) be readily obtainable using modern diagnostic tools; (3) be applicable to different cardiac diseases featuring diastolic heart failure. The present report of the European Study Group on Diastolic Heart Failure proposes a definition of primary diastolic heart failure. Primary diastolic heart failure does not include diastolic left ventricular dysfunction in the presence of systolic cardiac failure. Diagnostic criteria satisfying the originally proposed definition of diastolic heart failure will be established for most of the modern cardiac investigations and imaging techniques. Finally, these diagnostic criteria for diastolic heart failure will be applied to diseases frequently characterized by diastolic heart failure. To avoid low specificity of the diagnostic criteria, cut-off values of indices were set at the 95% confidence interval of the mean value of the index observed in a normal population. When age-related changes of an index have been reported, cut-off values are given for different age (y, years) groups (e.g. ¦30y; 30–50 y; §50y) indicated as subscripts to the index. How to establish the diagnosis of diastolic heart failure?