Diastolic dysfunction is known medically as heart failure with preserved ejection fraction (HFpEF). This condition occurs when the heart's ability to relax and fill with blood during the resting phase between beats (diastole) is compromised, despite maintaining a normal ejection fraction. The heart becomes stiff and less compliant, which impedes the efficient filling of the ventricles. The management of diastolic heart failure focuses on controlling symptoms, managing comorbid conditions, and improving quality of life through medications that enhance ventricular relaxation and compliance, as well as addressing lifestyle factors. Proper diagnosis and differentiation from systolic heart failure are essential for effective treatment, as the therapeutic approaches and prognoses differ between the two types of heart failure.
Conversely, systolic heart failure, also known as heart failure with reduced ejection fraction (HFrEF), is an issue that lies in the heart's pumping strength. The heart loses its ability to contract forcefully enough to circulate blood adequately throughout the body. This failure in the heart's pumping action leads to a reduced ejection fraction, which is a measurement of the percentage of blood leaving the heart each time it contracts. This results in less efficient blood circulation and a variety of symptoms and complications related to inadequate systemic perfusion.
Diastolic heart failure patients may experience similar symptoms to those with systolic heart failure, including shortness of breath, fatigue, and fluid buildup, because the heart cannot accommodate an adequate volume of blood to optimally perfuse the tissues of the body.
| Feature | Diastolic HF (HFpEF) | Systolic HF (HFrEF) |
|---|---|---|
| Core defect | Impaired relaxation and filling during diastole | Loss of contractile strength; inadequate forward circulation |
| Ejection fraction | Preserved (normal to elevated) | Reduced |
| Ventricular mechanics | Stiff, less compliant ventricle that impedes filling | Ventricle cannot contract forcefully enough |
| Echocardiogram | Normal EF with increased stiffness and impaired relaxation; altered E/e' ratio | Dilated ventricle with impaired contractility and decreased EF |
| Symptoms | Shortness of breath, fatigue, fluid buildup from inadequate ventricular filling | Shortness of breath, fatigue, fluid buildup from inadequate systemic perfusion |
| Management focus | Symptom control, comorbidity management, agents that improve relaxation and compliance | — |
