The main difference between diastolic heart failure and systolic heart failure is that the heart of a patient with diastolic heart failure has a normal ability to pump out blood. This is measured by ejection fraction, the percentage of blood pumped—or "ejected"—out of a filled pumping chamber ( ventricle) during each heartbeat.
To measure your ejection fraction, your doctor will order a Doppler echocardiogram to check the size of your main pumping chamber and determine if it is pumping out blood as it should. Diastolic heart failure usually has a normal ejection fraction of 50% or higher because the main pumping chamber is still pumping half or more of the blood it holds. However, the heart still pumps out less blood than normal because it is unable to relax and fill with enough blood. Women are more likely than men to have a high ejection fraction.27
You will be diagnosed with diastolic heart failure if your doctor finds you have signs and symptoms of heart failure, especially the backup and buildup of fluid (congestion) in the lungs, normal ejection fraction, and blood-filling problems caused by pumping chambers that have become too stiff to relax and fill with enough blood.10, 28
How is diastolic heart failure treated?
Diastolic heart failure has been less studied and understood than systolic heart failure. Although research on the conditions is progressing, the treatment of diastolic heart failure remains less well established than the treatment of systolic heart failure because there are only a few, small clinical trials on treating this type of heart failure. Therefore, many of the medications used to treat systolic heart failure are used to treat diastolic heart failure, focusing on reducing symptoms (such as fluid buildup) and controlling or treating the underlying cause.
The backup and buildup of fluid in the lungs and body can be controlled with diuretics.10 If your diastolic heart failure was caused by uncontrolled high blood pressure, your doctor can use angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) to normalize your blood pressure and reverse some of the ventricular thickening and impaired relaxation.10, 29 Beta-blockers, digoxin, and some calcium channel blockers may be used to slow a rapid heart rate ( tachycardia). Slowing your heart rate allows your heart's pumping chambers more time to relax and fill with blood.10
Is the outcome better with diastolic heart failure than with systolic heart failure?
Heart failure is a serious, potentially life-threatening condition, especially for those with more severe symptoms.30 Research regarding the outcome of diastolic heart failure compared with systolic heart failure varies greatly. Earlier studies reported a better outcome for people with diastolic heart failure,9, 31, 33 but more recent studies indicated that both forms of heart failure are equally serious and have similar prognosis.4, 32 Women with diastolic heart failure have a better chance of survival than men.34-35
It was thought that diastolic heart failure patients had a somewhat better outcome than those with systolic heart failure, from a yearly chance of death of 5% to 8% for diastolic heart failure compared with 10% to 15% for systolic heart failure.9 More recent studies, however, have found that diastolic heart failure can be almost as lethal as systolic heart failure, with about 30% dying in the first year and an additional 30% dying in the next four years.4, 32 These studies did not report results in women separately.
- Stromberg A, Martensson J. Gender differences in patients with heart failure. Eur J Cardiovasc Nurs. Apr 2003;2(1):7-18.
- Halm MA, Penque S. Heart failure in women. Prog Cardiovasc Nurs. Fall 2000;15(4):121-133.
- Masoudi FA, Havranek EP, Smith G, et al. Gender, age, and heart failure with preserved left ventricular systolic function. J Am Coll Cardiol. January 15, 2003;41(2):217-223.
- Bursi F, Weston SA, Redfield MM, et al. Systolic and Diastolic Heart Failure in the Community. JAMA. November 8, 2006;296(18):2209-2216.
- Hogg K, Swedberg K, McMurray J. Heart failure with preserved left ventricular systolic function: epidemiology, clinical characteristics, and prognosis. J Am Coll Cardiol. February 4, 2004;43(3):317-327.
- Kimmelstiel CD, Konstam MA. Heart failure in women. Cardiology. 1995;86(4):304-309.
- Ilksoy N, Hoffman M, Moore RH, Easley K, Jacobson T. Comparison of African-American Patients With Systolic Heart Failure Versus Preserved Ejection Fraction. Am J Cardiol. Sept 15 2006;98(6):806-808.
- Tandon S, Hankins SR, Le Jemtel TH. Clinical Profile of Chronic Heart Failure in Elderly Women. Am J Geriatr Cardiol. 2002;11(5):318-325.
- Zile MR, Brutsaert DL. New Concepts in Diastolic Dysfunction and Diastolic Heart Failure: Part I: Diagnosis, Prognosis, and Measurements of Diastolic Function. Circulation. March 19, 2002;105(11):1387-1393.
- Hunt SA. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure). J Am Coll Cardiol. September 20, 2005;46(6):e1-82.
- Senni M, Redfield MM. Heart failure with preserved systolic function: A different natural history? J Am Coll Cardiol. November 1, 2001;38(5):1277-1282.
- Klein AL, Burstow DJ, Tajik AJ, Zachariah PK, Bailey KR, Seward JB. Effects of age on left ventricular dimensions and filling dynamics in 117 normal persons. Mayo Clin Proc. Mar 1994;69(3):212-224.
- Mendes L, Davidoff R, Cupples LA, Ryan TJ, Jacobs A. Congestive heart failure in patients with coronary artery disease: The gender paradox. Am Heart J. 1997;134(2):207-212.
- Lund LH, Mancini D. Heart failure in women. Med Clin North Am. Sep 2004;88(5):1321-1345, xii.
- Krumholz HM, Larson M, Levy D. Sex differences in cardiac adaptation to isolated systolic hypertension. Am J Cardiol. Aug 1 1993;72(3):310-313.
- Alla F, Al-Hindi AY, Lee CR, Schwartz TA, Patterson JH, Adams KF. Relation of sex to morbidity and mortality in patients with heart failure and reduced or preserved left ventricular ejection fraction. Am Heart J. June 2007;153(6):1074-1080.
- Galderisi M, Anderson KM, Wilson PW, Levy D. Echocardiographic evidence for the existence of a distinct diabetic cardiomyopathy (the Framingham Heart Study). Am J Cardiol. Jul 1 1991;68(1):85-89.
- Gustafsson I, Brendorp B, Seibaek M, et al. Influence of diabetes and diabetes-gender interaction on the risk of death in patients hospitalized with congestive heart failure. J Am Coll Cardiol. March 3, 2004;43(5):771-777.
- He J, Ogden LG, Bazzano LA, Vupputuri S, Loria C, Whelton PK. Risk Factors for Congestive Heart Failure in US Men and Women: NHANES I Epidemiologic Follow-up Study. Arch Intern Med. April 9, 2001;161(7):996-1002.
- Ghali JK, Pina IL, Gottlieb SS, Deedwania PC, Wikstrand JC. Metoprolol CR/XL in female patients with heart failure: analysis of the experience in Metoprolol Extended-Release Randomized Intervention Trial in Heart Failure (MERIT-HF). Circulation. Apr 2 2002;105(13):1585-1591.
- Poirier P, Giles TD, Bray GA, et al. Obesity and Cardiovascular Disease: Pathophysiology, Evaluation, and Effect of Weight Loss: An Update of the 1997 American Heart Association Scientific Statement on Obesity and Heart Disease From the Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism. Circulation. February 14, 2006;113(6):898-918.
- Lauer MS, Anderson KM, Kannel WB, Levy D. The impact of obesity on left ventricular mass and geometry. The Framingham Heart Study. JAMA. July 10, 1991;266(2):231-236.
- Wong CY, O'Moore-Sullivan T, Leano R, Byrne N, Beller E, Marwick TH. Alterations of Left Ventricular Myocardial Characteristics Associated With Obesity. Circulation. November 9, 2004;110(19):3081-3087.
- Peterson LR, Waggoner AD, Schechtman KB, et al. Alterations in left ventricular structure and function in young healthy obese women: Assessment by echocardiography and tissue Doppler imaging. J Am Coll Cardiol. April 21, 2004;43(8):1399-1404.
- Avelar E, Cloward TV, Walker JM, et al. Left Ventricular Hypertrophy in Severe Obesity: Interactions Among Blood Pressure, Nocturnal Hypoxemia, and Body Mass. Hypertension. January 1, 2007;49(1):34-39.
- Fonarow GC, Stough WG, Abraham WT, et al. Characteristics, Treatments, and Outcomes of Patients With Preserved Systolic Function Hospitalized for Heart Failure: A Report From the OPTIMIZE-HF Registry. J Am Coll Cardiol. August 21, 2007;50(8):768-777.
- Chung AK, Das SR, Leonard D, et al. Women Have Higher Left Ventricular Ejection Fractions Than Men Independent of Differences in Left Ventricular Volume: The Dallas Heart Study. Circulation. March 28, 2006;113(12):1597-1604.
- Vasan RS, Levy D. Defining Diastolic Heart Failure : A Call for Standardized Diagnostic Criteria. Circulation. May 2, 2000;101(17):2118-2121.
- Chobanian AV, Bakris GL, Black HR, et al. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. December 1, 2003;42(6):1206-1252.
- Ahmed A, Aronow WS, Fleg JL. Higher New York Heart Association classes and increased mortality and hospitalization in patients with heart failure and preserved left ventricular function. Am Heart J. Feb 2006;151(2):444-450.
- Philbin EF, Rocco TA, Jr., Lindenmuth NW, Ulrich K, Jenkins PL. Systolic versus diastolic heart failure in community practice: clinical features, outcomes, and the use of angiotensin-converting enzyme inhibitors. Am J Med. Dec 1 2000;109(8):605-613.
- Owan TE, Hodge DO, Herges RM, Jacobsen SJ, Roger VL, Redfield MM. Trends in Prevalence and Outcome of Heart Failure with Preserved Ejection Fraction. N Engl J Med. July 20, 2006;355(3):251-259.
- Vasan RS, Larson MG, Benjamin EJ, Evans JC, Reiss CK, Levy D. Congestive heart failure in subjects with normal versus reduced left ventricular ejection fraction: Prevalence and mortality in a population-based cohort. J Am Coll Cardiol. June 1, 1999;33(7):1948-1955.
- Deswal A, Bozkurt B. Comparison of Morbidity in Women Versus Men With Heart Failure and Preserved Ejection Fraction. Am J Cardiol. 2006;97(8):1228-1231.
- Jones RC, Francis GS, Lauer MS. Predictors of mortality in patients with heart failure and preserved systolic function in the Digitalis Investigation Group trial. J Am Coll Cardiol. September 1, 2004;44(5):1025-1029.