Assessment and treatment of diastolic dysfunction

Congestive heart failure almost invariably includes a component of diastolic dysfunction, and in many patients impaired diastolic filling is the predominant functional abnormality. Failure of myocardial relaxation depends on abnormalities of calcium uptake as well as on the systolic and diastolic loads, the nonuniformity of load and the passive elastic characteristics of the ventricle. The availability of noninvasive diagnostic testing has led to an increasing interest in the study of diastolic function and its clinical implications. Recent echo-Doppler techniques (transesophageal pulmonary venous velocity recording, automatic endocardial borders detection, 3D cardiac reconstruction) demonstrated abnormal left ventricular filling patterns in patients with various cardiac disorders. It is possible that the diastolic abnormalities of heart failure may be a more appropriate target for new therapeutic interventions and several classes of pharmacologic agents may be effective in the management of diastolic dysfunction.