Heart Failure Reviews

, Volume 11, Issue 2, pp 141–146 | Cite as

The treatment of heart failure with preserved ejection fraction (“diastolic heart failure”)



Unlike heart failure with a low ejection fraction, there is no evidence-based treatment for heart failure with preserved ejection fraction which improves clinical outcomes. Indeed, the only evidence for any treatment effect comes from small studies with verapamil where this drug increased exercise capacity and reduced a heart failure score. Large trials are presently underway which are examining the effect of treatment with an ACE inhibitor, ARB and aldosterone antagonist in patients with heart failure and preserved ejection fraction.


Heart failure Diastolic Ejection fraction Preserved Drug treatment 


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  1. 1.
    Brutsaert DL. Diagnosing primary diastolic heart failure. Eur Heart J 2000;21:94–6.PubMedCrossRefGoogle Scholar
  2. 2.
    Caruana L, Petrie MC, Davie AP, McMurray JJ. Do patients with suspected heart failure and preserved left ventricular systolic function suffer from “diastolic heart failure” or from misdiagnosis? A prospective descriptive study. BMJ 2000;321:215–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Vasan RS, Levy D. Defining diastolic heart failure: A call for standardized diagnostic criteria. Circulation 2000;101:2118–21.PubMedGoogle Scholar
  4. 4.
    Caruana L, Davie AP, Petrie M, McMurray J. Diagnosing heart failure. Eur Heart J 1999;5:393.Google Scholar
  5. 5.
    Binkley PF, Shaffer PB, Ryan JM, Leier CV. Augmentation of diastolic function with phosphodiesterase inhibition in congestive heart failure. J Lab Clin Med 1989;3:266–71.Google Scholar
  6. 6.
    Monrad ES, McKay RG, Baim DS, Colucci WS, Fifer MA, Heller GV, Royal HD, Grossman W. Improvement in indexes of diastolic performance in patients with congestive heart failure treated with milrinone. Circulation 1984;6:1030–7.Google Scholar
  7. 7.
    Vasan RS, Benjamin EJ, Levy D. Prevalence, clinical features and prognosis of diastolic heart failure: an epidemiologic perspective. J Am Coll Cardiol 1995;7:1565–74.CrossRefGoogle Scholar
  8. 8.
    Senni M, Tribouilloy CM, Rodeheffer RJ, Jacobsen SJ, Evans JM, Bailey KR, Redfield MM. Congestive heart failure in the community: a study of all incident cases in Olmsted County, Minnesota, in 1991. Circulation 1998;21:2282–9.Google Scholar
  9. 9.
    Hogg K, Swedberg K, McMurray J. Heart failure with preserved left ventricular systolic function; epidemiology, clinical characteristics, and prognosis. J Am Coll Cardiol 2004;43:317–27.PubMedCrossRefGoogle Scholar
  10. 10.
    Weinberger HD. Diagnosis and treatment of diastolic heart failure. Hosp Pract 1999;3:115–8, 121–2, 125–6.CrossRefGoogle Scholar
  11. 11.
    Cody RJ. The treatment of diastolic heart failure. Cardiol Clin 2000;3:589–596.CrossRefGoogle Scholar
  12. 12.
    Remme WJ. How to treat diastolic heart failure: a personal point of view. Rev Port Cardiol 1999;5:V117–23.Google Scholar
  13. 13.
    Garcia MJ, Diastolic dysfunction and heart failure: Causes and treatment options. Cleve Clin J Med 2000;10:727–9, 733–8.Google Scholar
  14. 14.
    Vasan RS, Benjamin EJ. Diastolic heart failure—no time to relax. N Engl J Med 2001;1:56–9.CrossRefGoogle Scholar
  15. 15.
    Setaro JF, Zaret BL Schulman DS, Black HR, Soufer R. Usefulness of verapamil for congestive heart failure associated with abnormal left ventricular diastolic filling and normal left ventricular systolic performance. Am J Cardiol 1990;12:981–6.CrossRefGoogle Scholar
  16. 16.
    Hung MJ, Cherng WJ, Kuo LT, Wang CH. Effect of verapamil in elderly patients with left ventricular diastolic dysfunction as a cause of congestive heart failure. Int J Clin Pract 2002;56(1):57–62.PubMedGoogle Scholar
  17. 17.
    Aronow WS, Ahn C, Kronzon I. Effect of propranolol versus no propranolol on total mortality plus nonfatal myocardial infarction in older patients with prior myocardial infarction, congestive heart failure, and left ventricular ejection fraction > or = 40 treated with diuretics plus angiotensin-converting enzyme inhibitors. Am J Cardiol 1997;2:207–9.CrossRefGoogle Scholar
  18. 18.
    Flather MD, Shibata MC, Coats AJ, Van Veldhuisen DJ, Parkhomenko A, Borbola J, Cohen-Solal A, Dumitrascu D, Ferrari R, Lechat P, Soler-Soler J, Tavazzi L, Spinarova L, Toman J, Bohm M, Anker SD, Thompson SG, Poole-Wilson PA. SENIORS Investigators. Randomized trial to determine the effect of nebivolol on mortality and cardiovascular hospital admission in elderly patients with heart failure (SENIORS). Eur Heart J 2005;26:215–25.PubMedCrossRefGoogle Scholar
  19. 19.
    Aronow WS, Kronzon I. Effect of enalapril on congestive heart failure treated with diuretics in elderly patients with prior myocardial infarction and normal left ventricular ejection fraction. Am J Cardiol 1993;7:602–4.CrossRefGoogle Scholar
  20. 20.
    Cleland JG, Tendera M, Adamus J, Freemantle N, Grays CS, Lye M, O'Mahony D, Polonski L, Taylor J. Perindopril for elderly people with chronic heart failure: the PEP-CHF study. The PEP investigators. Eur J Heart Fail 1999;3:211–217.CrossRefGoogle Scholar
  21. 21.
    Yusuf S, Pfeffer MA, Swedberg K, Granger CB, Held P, McMurray JJ, Michelson EL, Olofsson B, Ostergren J. CHARM Investigators and Committees. Effects of candesartan in patients with chronic heart failure and preservedleft-ventricular ejection fraction: The CHARM-Preserved Trial. Lancet 2003;362:777–81.PubMedCrossRefGoogle Scholar
  22. 22.
    No authors listed. The effect of digoxin on mortality and morbidity in patients with heart failure. The Digitalis Investigation Group. N Engl J Med 1997;8:525–33.Google Scholar
  23. 23.
    Massie BM, Abdalla I. Heart failure in patients with preserved left ventricular systolic function: do digitalis glycosides have a role? Prog Cardiovasc Dis 1998;4:357–69.CrossRefGoogle Scholar
  24. 24.
    Ahmed A, Rich MW, Love TE, et al. Digoxin and reduction in mortality and hospitalization in heart failure: a comprehensive post hoc analysis of the DIG trial. Eur Heart J 2006;27:178–86.PubMedCrossRefGoogle Scholar
  25. 25.
    No authors listed. Double-blind placebo-controlled comparison of digoxin and xamoterol in chronic heart failure. The German and Austrian Xamoterol Study Group. Lancet 1988; i:489–93.Google Scholar
  26. 26.
    Carson P, Massie BM, McKelvie R, McMurray J, Komajda M, Zile M, Ptaszynska A, Frangin G, for the I-PRESERVE Investigators. The irbesartan in heart failure with preserved systolic function (I-PRESERVE) trial: rationale and design. J Card Fail 2005; 11(8):576–85. (I-PRESERVE)PubMedCrossRefGoogle Scholar
  27. 27.
  28. 28.
    Yancy CW, Lopatin M, Stevenson LW, De Marco T, Fonarow GC, for the ADHERE Scientific Advisory Committee and Investigators. Clinical presentation, management, and in-hospital outcomes of patients admitted with acute decompensated heart failure with preserved systolic function. J Am Coll Cardiol 2006;47:76–84.PubMedCrossRefGoogle Scholar
  29. 29.
    Pepine CJ, Handberg EM, Cooper-DeHoff RM, et al. A calcium antagonist vs a non-calcium antagonist hypertension treatment strategy for patients with coronary artery disease. The International Verapamil-Trandolapril Study (INVEST): a randomized controlled trial. JAMA 2003;290:2805–16.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2006

Authors and Affiliations

  1. 1.Department of Cardiology, Clinical Research Initiative in Heart FailureUniversity of Glasgow Western InfirmaryGlasgowUnited Kingdom

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