Diastolic heart failure, diastolic left ventricular dysfunction and exercise intolerance.

The phenomenon of “diastolic heart failure” is rightly receiving greater attention (1–4); community-based studies such as those in Framingham (5) and Olmsted County (6) show that up to 50% of older persons with heart failure do not have impaired left ventricular (LV) systolic function to account for this, and that the condition is usually associated with LV hypertrophy and is preceded by elevation of systolic blood pressure. Modern medicine has been slow to accept diastolic dysfunction as a cause of heart failure, largely because there are no accepted noninvasive measures of diastolic dysfunction, there is a wide overlap in diastolic function between persons with apparent diastolic heart failure and the normal aged community, and the profession has focused on impaired LV systolic function and coronary atherosclerosis as the cause of myocardial scarring and impaired LV contractility. Up until the year 2000 there had been no randomized therapeutic studies of patients with diastolic LV dysfunction. With a blank slide, Dr. W. Little of Wake Forest University illustrated this to packed sessions of the 49th and 50th American College of Cardiology (ACC) meetings.