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Invited Commentary
June 27, 2011

Diastolic Dysfunction and Heart Failure With Preserved Ejection Fraction in WomenComment on “Mortality Rate in Patients With Diastolic Dysfunction and Normal Systolic Function”

Author Affiliations

Author Affiliation: Departments of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio.

Arch Intern Med. 2011;171(12):1088-1089. doi:10.1001/archinternmed.2011.245

The greater our knowledge increases, the greater our ignorance unfolds.—John F. Kennedy

Heart failure remains the No. 1 discharge diagnosis for Medicare recipients in US hospitals. More than 40% of patients admitted for acutely decompensated heart failure have preserved systolic function (ie, heart failure with preserved ejection fraction [HFPEF]) and DD.1 As therapies for HF with reduced EF improve outcomes, proportionally more patients will present with HFPEF, many of whom will be older women and will have hypertension and/or diabetes mellitus. The in-hospital mortality rate may be low2,3 but after discharge it can be as high as that of patients with impaired systolic function.1,4 Indeed, as well stated by Yip and colleagues,5 diastolic dysfunction is only one of many pathophysiologic derangements in DD and incorrectly may lead the physician to target therapy only to diastole.6,7 As such, HFPEF mechanisms are complex and include metabolic and mechanical abnormalities of systole and diastole. The added effects of hypertension and diabetes mellitus, among comorbidities, cannot be ignored. Yet, the diagnosis of HFPEF usually is made based on symptoms while physicians look to the echocardiographic test results to “seal” the diagnosis of DD.

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