Diastolic Dysfunction and Heart Failure Epidemiology
Summary
Diastolic dysfunction arises when the left ventricle fails to relax or fill normally during diastole, often despite a preserved ejection fraction. This impairment leads to elevated filling pressures, pulmonary congestion and, ultimately, symptoms of heart failure. While systolic heart failure has long dominated research and clinical practice, diastolic dysfunction and heart failure with preserved ejection fraction (HFpEF) account for roughly half of all heart failure cases worldwide. Ageing populations, increasing prevalence of hypertension, obesity and diabetes have driven a rising incidence of diastolic heart failure. Epidemiological studies reveal that prevalence varies between 20 % and 50 % among elderly cohorts, with rates influenced by sex, ethnicity and comorbidities. Women, in particular, exhibit a higher lifetime risk of HFpEF, reflecting distinct pathophysiological mechanisms such as microvascular inflammation and myocardial stiffening. Global burden is greatest in regions with rapid demographic ageing and limited access to early diagnostic imaging. Surveillance using echocardiography, biomarkers and community-based cohort studies has improved understanding of risk factor trajectories. However, heterogeneity in diagnostic thresholds, variable reporting of incidence and scant data from under-represented populations continue to hamper global comparisons and targeted public health strategies.
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Diastolic Dysfunction and Heart Failure Epidemiology publication trend
The graph below shows the total number of articles in diastolic dysfunction and heart failure epidemiology across all publications each year (not limited to Nature Index journals).
Technical terms
Diastolic dysfunction: Impaired relaxation or filling of the left ventricle during diastole, leading to elevated filling pressures.
Heart failure with preserved ejection fraction (HFpEF): A form of heart failure in which left ventricular ejection fraction remains ≥50% despite symptomatic cardiac impairment.
Left ventricular ejection fraction (LVEF): The proportion of blood ejected from the left ventricle with each heartbeat, expressed as a percentage.
E/e′ ratio: An echocardiographic index comparing transmitral early filling velocity (E) to mitral annular velocity (e′), used to estimate left ventricular filling pressures.
Pulse wave velocity: A measure of arterial stiffness determined by the speed at which pressure waves move along the arterial tree.
References
- Arterial stiffness and its associations with left ventricular diastolic function according to heart failure types. Clinical Hypertension (2023).
- Prevalence of left ventricular diastolic dysfunction in European populations based on cross-validated diagnostic thresholds. Cardiovascular Ultrasound (2012).
- Diastolic dysfunction and sex-specific progression to HFpEF: current gaps in knowledge and future directions. BMC Medicine (2022).
- Risk factors for longitudinal changes in left ventricular diastolic function among women and men. Heart (2019).
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