Katina Tzanetos and colleagues comprehensively reviewed the literature on the phenomenon that has become known as diastolic heart failure. 1 It is becoming recognized that the binary categorization of heart failure as either systolic or diastolic heart failure on the basis of an arbitrary cut-off for left ventricular ejection fraction is oversimplified and misguided. 2
Recent studies have shown that significant numbers of patients diagnosed with diastolic heart failure have demonstrable systolic dysfunction when detailed echocardiographic investigations are conducted. 3,4 Moreover, in a large population-based study, Bursi and colleagues reported that advanced objective echocardiographic parameters of diastolic dysfunction were present in 83% of patients with heart failure who had a low left ventricular ejection fraction (i.e., patients with systolic heart failure) and that this dysfunction was more severe than in patients with diastolic heart failure. 5 Similarly, Brucks and colleagues demonstrated in patients with systolic heart failure that objective parameters of diastolic dysfunction were not only highly prevalent but also more predictive of mortality than left ventricular ejection fraction itself. 6
Systole and diastole need to be recognized as active and complementary components of the cardiac cycle, both contributing to overall myocardial performance. They are not separate entities, and one of them can only be as effective as the other allows. Thus, in reality, systolic and diastolic dysfunction coexist to varying degrees. 2 The continuing disagreement in major international guidelines over diagnostic criteria 7,8 casts doubt on the accuracy of the patient selection process for studies to date and, therefore, the validity of these studies’ results. A universally accepted definition and criteria for diagnosis would allow cases of heart failure in which left ventricular diastolic dysfunction predominates to be correctly identified and subsequently characterized.
Footnotes
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Competing interests: None declared.
REFERENCES
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