Feature Article

Diastolic heart failure: a clinical update

Suchitra Chandar, Charles Pawsey, Leonard Kritharides



Although the clinical syndrome of heart failure is usually secondary to impaired left ventricular contraction, a significant number of patients with this syndrome have isolated diastolic dysfunction. Systolic and diastolic heart failure may be clinically indistinguishable; the mainstays of establishing a diagnosis of diastolic heart failure are noninvasive techniques, such as echocardiography.

Key Points

  • Although systolic and diastolic dysfunction heart failure coexist, a significant number of patients have pure diastolic heart failure.
  • Pure diastolic failure is characterised by congestive cardiac failure, normal or almost normal systolic function, and abnormal left ventricular relaxation, filling and/or stiffness.
  • Echocardiography is a useful tool for diagnosing diastolic dysfunction, demonstrating its aetiology, and excluding systolic left ventricular dysfunction.
  • Treatment of pure diastolic heart failure, although empirical, requires addressing potential reversible processes, such as hypertension, atrio-ventricular synchrony, and ischaemia.
  • It is important that lifestyle measures are not overlooked. These include restricted salt intake, avoidance of alcohol, regular physical activity and pneumococcal and influenza vaccinations.