Pre-clinical diastolic dysfunction

Abstract

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.

Keywords: B-type natriuretic peptide; BNP; COPD; DD; EF; HF; HFpEF; HFrEF; LV; LVH; N-terminal pro–B-type natriuretic peptide; NT-proBNP; PDD; SD; chronic obstructive pulmonary disease; diastolic dysfunction; echocardiography; ejection fraction; heart failure; heart failure epidemiology; heart failure treatment; heart failure with preserved ejection fraction; heart failure with reduced ejection fraction; left ventricular; left ventricular hypertrophy; pre-clinical diastolic dysfunction; systolic dysfunction.

Figure 1. Cardiovascular and noncardiac risk factors in the development and progression of preclinical diastolic dysfunction (PDD) and heart failure with preserved ejection fraction (HFpEF)

Cardiovascular risk factors contribute to the development of preclinical diastolic dysfunction (Stage B). Both cardiovascular and noncardiac risk factors contribute to the progression from preclinical diastolic dysfunction to symptomatic heart failure with preserved ejection fraction (Stage C/D). While survival decreases dramatically in symptomatic heart failure, the duration of Stage A and B heart failure with regards to survival remains to be fully elucidated