Pre-Clinical Diastolic Dysfunction

• Published in: Journal of the American College of Cardiology Vol. 63; no. 5; pp. 407 - 416
• Main Authors: Wan, Siu-Hin, MD, Vogel, Mark W., MD, Chen, Horng H., MB, BCh
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 11.02.2014; Elsevier; Elsevier Limited
• Subjects: Age; Biological and medical sciences; Cardiology; Cardiology. Vascular system; Cardiovascular; Cardiovascular disease; Diabetes; Diastole; diastolic dysfunction; Disease Progression; Echocardiography; Global Health; Heart; Heart attacks; Heart failure; Heart Failure - epidemiology; Heart Failure - etiology; Heart Failure - physiopathology; heart failure treatment; heart failure with preserved ejection fraction; Heart Ventricles - diagnostic imaging; Heart Ventricles - physiopathology; Humans; Internal Medicine; Medical sciences; Mortality; Population; Prevalence; Prognosis; Risk Factors; Stroke Volume; Studies; Ventricular Dysfunction, Left - complications; Ventricular Dysfunction, Left - epidemiology; Ventricular Dysfunction, Left - physiopathology; DD; ejection fraction; BNP; echocardiography; heart failure treatment; LV; systolic dysfunction; HFpEF; HFrEF; PDD; pre-clinical diastolic dysfunction; SD; heart failure with preserved ejection fraction; NT-proBNP; heart failure epidemiology; left ventricular; heart failure with reduced ejection fraction; EF; heart failure; B-type natriuretic peptide; left ventricular hypertrophy; diastolic dysfunction; N-terminal pro–B-type natriuretic peptide; HF; COPD; chronic obstructive pulmonary disease; LVH; Cardiovascular disease; Circulatory system; Cardiology; Dysfunction
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2013.10.063

Pre-clinical diastolic dysfunction (PDD) has been broadly defined as left ventricular diastolic dysfunction without the diagnosis of congestive heart failure (HF) and with normal systolic function. PDD is an entity that remains poorly understood, yet has definite clinical significance. Although few original studies have focused on PDD, it has been shown that PDD is prevalent, and that there is a clear progression from PDD to symptomatic HF including dyspnea, edema, and fatigue. In diabetic patients and in patients with coronary artery disease or hypertension, it has been shown that patients with PDD have a significantly higher risk of progression to heart failure and death compared with patients without PDD. Because of these findings and the increasing prevalence of the heart failure epidemic, it is clear that an understanding of PDD is essential to decreasing patients' morbidity and mortality. This review will focus on what is known concerning pre-clinical diastolic dysfunction, including definitions, staging, epidemiology, pathophysiology, and the natural history of the disease. In addition, given the paucity of trials focused on PDD treatment, studies targeting risk factors associated with the development of PDD and therapeutic trials for heart failure with preserved ejection fraction will be reviewed.