Management of Diastolic Heart Failure

  • Starry H. Rampengan Fakultas Kedokteran Unsrat/BLU RSUP Prof dr RD Kandou Manado
Keywords: Diastolic heart failure, management


The diastolic heart failure also referred to as heart failure with preserved left ventricular systolic function (preserved ejection fraction). The difference between systolic and diastolic HFs is a pathophysiological one and isolated forms of left ventricular dysfunction are rarely observed. In diastolic HF left ventricular systolic function is normal or only slightly impaired, and the typical manifestations of HF result from increased filling pressure caused by impaired relaxation and compliance of the left ventricle. The management should include antihypertensive treatment, maintenanceof the sinus rhythm, prevention of tachycardia, venous pressure reduction, prevention of myocardial ischemia and prevention of diabetes mellitus. Treatment of diastolic HF is aimed to stop the progression of the disease, relieve its symptoms, eliminate exacerbations and reduce the mortality. The predisposing factors for diastolic dysfunction include elderly age, female sex, obesity, coronary artery disease, hypertension and diabetes mellitus. The European Society of Cardiology specifies the type of therapy in diastolic HF based on: angiotensin converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, non dihydropyridine calcium channel blockers, diuretics.


Download data is not yet available.


Dickstein K, Cohen-Solal A, Fillippatos G et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J, 2008; 29: 2388-2442.

Grossman W. Defining diastolic dysfunction. Circulation. 2000; 101: 2020-2021.

Van Heerebeek L, Borbly A, Niessen HW et al. Myocardial structure and function differ in systolic and diastolic heart failure. Circulation, 2006; 113: 774-781.

Opolski G eds. Kardiologia. 1st Ed. Urban & Partner, Wroclaw 2003.

Nagueh SF, Appleton CP, Gillebert TC et al. Recommendation for the evaluations of the left ventricular diastolic function by echocardiography. Eur J Echocardiogr, 2009; 10: 165-193.

Aurigemma GP. Diastolic heart failure: A common and lethal codition by any name. N Engl J Med, 2006; 355: 308-310.

Jessup M, Abraham WT, Casey DE et al. ACCF/AHA guidelines for the diagnosis and management of heart failure in adult: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 2009; 119: 1977-2016.

Gandhi SK, Powers JC, Nomeir AM et al. The pathogenesis of acute pulmonary edema associated with hypertension. N Engl J Med, 2001; 244: 17-22.

Dahlof B, Devereux RB, Kjedsen SE et al. Cardiovascular morbidity and mortality in the Losartan intervention For Endpoint reduction in hypertension study (LIFE): A randomised trial againts atenolol. Lancet, 2002; 359: 995-1003.

Yusuf S, Pfeffer MA, Swedberg K et al. Effects of candesartan in patients with chonic heart failure and preserved left ventricular ejection fraction: The CHARM-Preserved Trial. Lancet, 2003;362: 771-781.

Cleland JGF, Tendera M, Adamus J et al. The perindopril in elderly people with chronic heart failure (PEP-CHF) study. Eur Heart J, 2006; 27: 2338-2345.

Solomon SD, Janardhanan R, Verma A et al. ;for the valsartan in Diastolic Dysfunction (VALIDD) Investigators. Effect of angiotensin receptor blockade and antihypertensive drugs on diastolic function in patients with hypertension and diastolic dysfunction: A randomised trial. Lancet, 2007; 369: 2079-2087.

Kostis JB, Davis BR, Cutler J et al. Prevention on heart failure by antihypertensive drug treatment in older person with isolated systolic hypertension. SHEP Cooperative Research Group. JAMA, 1997; 278: 212-216.

Ofili EO, Cohen JD, St. Vrain J et al. Effect of treatment of isolated systolic hypertension on left ventricular mass. JAMA. 1998; 278-780.

Bergstorm A, Adersson B, Edner M et al. effect of carvedilol on diastolic dysfunction in patients with diastolic heart failure and preserved systolic function. Result of the Swedih Doppler-echocardiographic study (SWEDIC). Eur J Heart Fail, 2004; 6: 453-461.

Tendera M, Schneeweiss A, Bartoszewski A et al. The acute response of the left ventricular filling dynamics to intravenous verapamil predicts the changes in exercise tolerance after oral verapamil therapy in patients with hypertropic cardiomyopathy, Eur Heart J. 1993; 14: 410-415.

Ghio S, Magrini G Serio A et al. SENIORS investigators. Effects of nebivolol in elderly heart failure patients with or without systolic left ventricular dysfunction: Results of the SENIORS echocardiographic substudy. Eur Heart J, 2006; 27:562-568.

The Digitalis Investigation Group. The effect of digoxin on mortality and morbidity in patients with heart failure. N Engl J Med, 1997; 336: 325-533.

Kramer K, Kirkman P, Kitzman D et al. Flash pulmonary edema: association with hypertension and reoccurrence despite coronary revascularization. Am Heart J, 2000; 40: 451-455.

Fukuda H, Sane D, Brucks S et al. Statin therapy may be associated with lower mortality in patients with diastolic heart failure. A preliminary report. Circulation, 2005; 112: 357-363.


Abstract viewed :
95 times
PDF downloaded : 372 times

How to Cite
Rampengan, S. (2015). Management of Diastolic Heart Failure. Indonesian Journal of Cardiology, 35(1), 50-8.
Review Article