DIFFERENTIATING SYSTOLIC FROM DIASTOLIC HEART-FAILURE - PATHOPHYSIOLOGIC AND THERAPEUTIC CONSIDERATIONS

PURPOSE: To compare and contrast the pathophysiology and therapy of he art failure with normal and abnormal systolic ventricular function. ME THODS: Review of basic pathophysiologic mechanisms, clinical data, and therapeutic trials. CONCLUSIONS: The clinical features of heart failu re may be similar regardless of whether ventricular function is normal or abnormal. However, the pathophysiologic mechanisms leading to hear t failure with normal ventricular function differ considerably from th ose producing heart failure with abnormal systolic function. The key p roblems in heart failure with abnormal systolic function involve impai red contractility, neuroendocrine activation, increased intracardiac v olume and pressure, and enhanced sensitivity to change in afterload. W ith normal systolic function, the key problem is an abnormal diastolic pressure/volume relationship, which may be due to a variety of active and passive processes affecting diastole. Assessing left ventricular systolic function is crucial before initiating therapy in a patient wi th heart failure, since treatment for systolic dysfunction may be inef fective or even counterproductive if symptoms are due to abnormal dias tolic properties with preserved systolic function.