Author + information
- Received March 15, 2013
- Revision received October 8, 2013
- Accepted October 15, 2013
- Published online February 11, 2014.
- ∗Department of Internal Medicine, Mayo Clinic and Foundation, Rochester, Minnesota
- †Division of Cardiovascular Diseases, Washington University, St. Louis, Missouri
- ‡Division of Cardiovascular Diseases, Mayo Clinic and Foundation, Rochester, Minnesota
- ↵∗Reprint requests and correspondence:
Dr. Horng H. Chen, Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905.
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.
- diastolic dysfunction
- heart failure epidemiology
- heart failure treatment
- heart failure with preserved ejection fraction
This research was supported by grants from the National Institutes of Health P01 HL 76611 and R01 HL-84155 and by the Mayo Foundation. Dr. Chen is the cofounder and chief medical officer of Zumbro Discovery; has received royalties from Nile Therapeutics, Anexon Inc., and UpToDate Inc.; and, through Mayo Clinic, holds patents on chimeric natriuretic peptides. Drs. Wan and Vogel have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 15, 2013.
- Revision received October 8, 2013.
- Accepted October 15, 2013.
- American College of Cardiology Foundation