Natural history of diastolic heart failure

Heart failure may develop with either reduced or preserved left ventricular ejection fraction (LVEF), with each form accounting for approximately half of cases.  However, time-dependent changes in diastolic function have not been well investigated, and their relationship to clinical heart failure is not well understood.

In this study Kane et al. report on the follow-up of 2042 patients randomly selected from the Olmsted County Heart Function Study (OCHFS), all of whom had undergone an initial assessment of diastolic dysfunction between 1997-2001.  After four years, participants attended for a second examination and then underwent clinical follow-up to ascertain new-onset heart failure cases until 2010.  The main outcome measure was the change in diastolic function grade and incident heart failure.

Over the four years between the participants’ first and second clinical examination, diastolic dysfunction prevalence was seen to increase from 23.8% to 39.2% (p<0.001).  Diastolic function grade worsened in 23.4% and improved in 8.8%; worsened diastolic dysfunction was associated with being over 65 years of age (OR, 2.85).  During 6.3 years of clinical follow-up, heart failure occurred in 12.2% of patients whose diastolic dysfunction remained or progressed to moderate or severe dysfunction.


This large population-based study suggests that the prevalence of diastolic dysfunction increases over time, and was associated with the development of heart failure during six years of subsequent follow-up.

  • Kane GC, Karon BL, Mahoney DW et al.  Progression of Left Ventricular Diastolic Dysfunction and Risk of Heart Failure.  JAMA 2011;306:856-863.

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