Left bundle branch pacing vs biventricular pacing in heart failure patients with left bundle branch block:A systematic review and meta-analysis

BACKGROUND Left bundle branch pacing(LBBP)is a novel pacing modality of cardiac resynchronization therapy(CRT)that achieves more physiologic native ventricular activation than biventricular pacing(BiVP).AIM To explore the validity of electromechanical resynchronization,clinical and echocardiographic response of LBBP-CRT.METHODS Systematic review and Meta-analysis were conducted in accordance with the standard guidelines as mentioned in detail in the methodology section.RESULTS In our analysis,the success rate of LBBP-CRT was determined to be 91.1%.LBBP CRT significantly shortened QRS duration,with significant improvement in echocardiographic parameters,including left ventricular ejection fraction,left ventricular end-diastolic diameter and left ventricular end-systolic diameter in comparison with BiVP-CRT.CONCLUSION A significant reduction in New York Heart Association class and B-type natriuretic peptide levels was also observed in the LBBP-CRT group vs BiVP-CRT group.Lastly,the LBBP-CRT cohort had a reduced pacing threshold at follow-up as compared to BiVP-CRT.

IN PATIENTS WITH HYPERTENSIVE LEFT VENTRICULAR HYPERTROPHY AND CORONARY HEART DISEASE,CORONARY FLOW RESERVE IS SIMILARLY IMPAIRED

Coronary blood flow reserve (CFR) was assessed by transesophageal Doppler echocardiography in normal subjects (group A. n=20),hypertensive non-left ventricular hypertrophy (non-LVH)Patients (group B,n=22). hypertensive patients with LVH(group C.n=32)and coronary heart disease patients (group D. n=33) with the volume sample placed at the bifurcation of the left main and left main and left descending coronary artery. Coronary blood flow velocity (CBFV)was evaluated at rest.2 minutes after dipyridamole (0. 56mg/kg. i. v.) . and 2 minutes after aminophylline i.v. The ratio of dipyridamole to rest maximal diastolic velocity (D/R PDV) was considered the index of coronary blood flow reserve.It was found that D/R PDV was significantly less in groups C and D compared with that in groups A and B (D PDC,1.84±0. 57. 1. 57±0. 41 versus 2.59±0.70 and 2.22+0.58,respectively),with no difference in D/R PDV between groups C and D.Twenty-four out of 32 patients in group C with D/R PDV were less than 2.0 compared to 29 out of 33 patients in group D (P>0.05).Significant negative correlation was found between D/R PDV. D/R PSV and interseptal thickness. left ventricular mass index in hypertensive patients.These data show that impaired CFR in hypertensive patients with LVH is comparable to that in patients with coronary heart disease.

Plasma Norepinephrine and Hemorheology in Essential Hypertensive Patients with Different Patterns of Left Ventricular Hypertrophy

对80例不同类型高血压左室肥厚（LVH）患者的血浆去甲肾上腺素（NE）和血液流变学改变进行观察。结果显示，（1）向心性肥厚组（CH）高切变率下全血粘度（WBV230）显著升高；（2）不对称性室间隔肥厚组（ASH）血浆NE和收缩末期室壁应力（ESS）增高较明显；（3）多元回归分析显示，SBP，ESS和血浆NE是影响相对室壁厚度的重要因素。提示CH是一种对压力负荷过重而产生的代偿形式；ASH的形成除了负荷因素外血浆NE可能起更重要的作用。

Heart failure and left ventricular dysfunction in older patients with chronic kidney disease: the China Hypertension Survey (2012‒2015)

Background Heart failure(HF)is a leading cause of hospitalization and mortality for older chronic kidney disease(CKD)patients.However,the epidemiological data is scarce.We aimed to determine the prevalence of left ventricular(LV)dysfunction and HF,and to explore the risk factors for HF among those patients.Methods This is a cross-sectional analysis of the China Hypertension Survey conducted between October 2012 and December 2015.A total of 5,808 participants aged≥65 years were included in the analysis.Self-reported history of HF and any other cardiovascular diseases was acquired.2-D and Doppler echocardiography were used to assess LV dysfunction.CKD was defined as either estimated glomerular filtration rate(eGFR)<60 mL/min per 1.73 m2 or urinary albumin to creatinine ratio(ACR)≥30 mg/g.Results Among CKD patients aged≥65 years,the weighted prevalence of HF,heart failure with preserved ejection fraction(HFpEF),heart failure with mid-range ejection fraction(HFmrEF),and heart failure with reduced ejection fraction(HFrEF)was 4.8%,2.5%,0.8%,and 1.7%,respectively.The weighted prevalence of HF was 5.0%in patients with eGFR<60 mL/min per 1.73 m2,and was 5.9%in patients with ACR≥30 mg/g.The prevalence of LV systolic dysfunction was 3.1%,and while it was 8.9%for moderate/severe diastolic dysfunction.Multivariate analysis showed that smoking was significantly associated with the risk of HF.Furthermore,age,smoking,and residents in rural areas were significantly associated with a risk of LV diastolic dysfunction.Conclusions The prevalence of HF and LV dysfunction was high in older patients with CKD,suggesting that particular strategies will be required.

Real-time Three-dimensional Echocardiographic Assessment of Left Ventricular Remodeling Index in Patients with Hypertensive Heart Disease and Coronary Artery Disease

Left ventricular remodeling index （LVRI） was assessed in patients with hypertensive heart disease （HHD） and coronary artery disease （CAD） by real-time three-dimensional echocardiography （RT3DE）. RT3DE data of 18 patients with HHD, 20 patients with CAD and 22 normal controis （NC） were acquired. Left ventricular end-diastolic volume （EDV） and left ventricular end-diastolic epicardial volume （EDVepi） were detected by RT3DE and two-dimensional echocardiography Simpson biplane method （2DE）. LVRI （left ventricular mass/EDV） was calculated and compared. The results showed that LVRI measurements detected by RT3DE and 2DE showed significant differences inter-groups （P〈0.01）. There was no significant difference in NC group （P〉0.05）, but significant difference in HHD and CAD intra-group （P〈0.05）. There was good positive correlations between LVRI detected by RT3DE and 2DE in NC and HHD groups （t=0.69, P〈0.01; r=0.68, P〈0.01）, but no significant correlation in CAD group （r=0.30, P〉0.05）. It was concluded that LVRI derived from RT3DE as a new index for evaluating left ventricular remodeling can provide more superiority to LVRI derived from 2DE.

Diagnosis and treatment of heart failure with preserved left ventricular ejection fraction

Nearly six million people in United States have heart failure.Fifty percent of these people have normal left ventricular(LV)systolic heart function but abnormal diastolic function due to increased LV myocardial stiffness.Most commonly,these patients are elderly women with hypertension,ischemic heart disease,atrial fibrillation,obesity,diabetes mellitus,renal disease,or obstructive lung disease.The annual mortality rate of these patients is 8%-12%per year.The diagnosis is based on the history,physical examination,laboratory data,echocardiography,and,when necessary,by cardiac catheterization.Patients with obesity,hypertension,atrial fibrillation,and volume overload require weight reduction,an exercise program,aggressive control of blood pressure and heart rate,and diuretics.Miniature devices inserted into patients for pulmonary artery pressure monitoring provide early warning of increased pulmonary pressure and congestion.If significant coronary heart disease is present,coronary revascularization should be considered.

Electrophysiological changes of autonomic cells in left ventricular outflow tract in guinea pigs with iron deficiency anemia complicated with chronic heart failure

Objective: To investigate the electrophysiological changes of autonomic cells in left ventricular outflow tract in guinea pigs with iron deficiency anemia complicated with chronic heart failure.Methods: Guinea pigs model of iron deficiency anemia complicated with chronic heart failure in 10 guinea pigs of the experimental group was made by feeding a low iron diet,pure water and subcutaneous injection of isoproterenol. The control group consisting of 11 guinea pigs was given normal food, normal water and injected with normal saline. The left ventricular outflow tract model specimen was also prepared. The standard microelectrode technique was used to observe electrophysiological changes of autonomic cells in the outflow tract of left ventricular heart failure complicated with iron deficiency anemia in guinea pig model. The indicators of observation were maximal diastolic potential, action potential amplitude, 0 phase maximal depolarization velocity, 4 phase automatic depolarization velocity, repolarization 50% and 90%, and spontaneous discharge frequency.Results: Compared with the control group, 4 phase automatic depolarization velocity,spontaneous discharge frequency and 0 phase maximal depolarization velocity decreased significantly(P < 0.01) and action potential amplitude reduced(P < 0.01) in model group. Moreover, repolarization 50% and 90% increased(P < 0.01).Conclusions: There are electrophysiological abnormalities of the left ventricular outflow tract in guinea pigs with iron deficiency anemia complicated with heart failure.

The effect of Rhodiolae treating chronic myocardial infarction with heart failure on left ventricular remodeling and serum inflammatory factors

Objective:To explore the effect of rhodiolae treating chronic myocardial infarction with heart failure on left ventricular remodeling and serum inflammatory factors.Methods:A total of 100 cases of chronic myocardial infarction with heart failure were selected and randomly divided into treatment group and control group with 50 cases in each group, the control group was treated with strong heart, dehydration, nutrition myocardium, infection prevention and western comprehensive treatment, the treatment group was given rhodiola treatment based on the western medicine treatment, compared the changes of left ventricular remodeling indexes and serum inflammatory factors of two group patients before treatment (T0), 1 months of treatment (T1), 3 months of treatment (T2).Results: (1) There was statistical significance difference at different time points LVEF, LVEDD, LVESD, LVSTD, LVPWTD. LVEF, LVSTD, LVPWTD: T2 > T1 > T0, LVEDD, LVESD: T2 < T1 < T0;In treatment group LVEF, LVSTD and LVPWTD increased, and the decline rate of LVEDD and LVESD was higher than that of control group;(2) There was statistically significant difference in different time points of IL-6, hs-CRP, and NT-proBNP, serum IL-6, hsCRP and NT-proBNP levels: T2 < T1 < T0;The serum IL-6, hs-CRP and NT-proBNP levels of treatment group decreased more than control group.Conclusion: Rhodiolae is helpful to improve the left ventricular remodeling and serum inflammatory factors in patients with chronic myocardial infarction and heart failure.

Correlation between IL-33/sST2 signaling pathway and patients with essential hypertensive left ventricular hypertrophy

Objective:To detect the levels of interleukin-33(IL-33)and soluble ST2(sST2)in peripheral blood of patients with essential hypertensive left ventricular hypertrophy,and to discusstheir correlation with patients with essential hypertensive left ventricular hypertrophy was further discussed.Methods:A total of 220 patients with essential hypertension treated in the Department of Cardiovascular Medicine of the First Affiliated Hospital of Bengbu Medical College were enrolled as the experimental group.According to left ventricular mass index(LVMI),patients with essential hypertension were divided into the non-left ventricular hypertrophy group(NLVH,n=108 cases)and the left ventricular hypertrophy group(LVH,n=112 cases).We used ELISA to detect the serum levels of IL-33 and sST2,the expression levels of IL-33 in peripheral blood lymphocytes of the NLVH group and the LVH group(60 cases each)were detected by Western blot,and the relationship between IL-33 and LVMI,a marker of left ventricular hypertrophic condition,was analyzed by Pearson.The relationship between IL-33,sST2 and left ventricular hypertrophy in essential hypertension was studied.Results:Compared with the NLVH group,the expression levels of IL-33 and sST2 in the LVH group were significantly increased.The results of Western blot showed that the expression level of IL-33 in the LVH group(1.07±0.08)was higher than that in the NLVH group(0.63±0.05)(P<0.05).Pearson correlation analysis showed that IL-33 was positively correlated with LVMI,sST2 was positively correlated with LVMI.Conclusion:The levels of IL-33 and sST2 in serum and the expression levels of IL-33 protein in peripheral blood lymphocytes are significantly increased in patients with hypertensive left ventricular hypertrophy,and the occurrence and development of essential hypertensive left ventricular hypertrophy may be related to IL-33 and sST2.

Effect of Osteoprotegerin and XRCC3 Genes Polymorphisms with the Occurrence of Left Ventricular Hypertrophy in Hypertensive Patients

Background: High blood pressure is associated with adverse morphological and functional changes in the cardiovascular system, including left ventricular hypertrophy (LVH). Osteoprotegerin (OPG) is a member of the tumor necrosis factor receptor superfamily of cytokines. X-ray repair cross-complementing protein 3 (XRCC3) is involved in the repair pathway for double-strand breaks (DSBs). We assessed the association of osteoprotegerin and XRCC3 gene polymorphisms with the occurrence of left ventricular hypertrophy in hypertensive patients. Patients and methods: The study included 50 hypertensive patients: 25 with LVH (group A) and 25 without LVH (group B). All cases were subjected to complete history taking and clinical examination. ECG and echocardiography were done. LV mass was calculated to detect the presence or absence of LV hypertrophy. DNA was extracted from blood samples, and then, each DNA sample was amplified in PCRs, to detect osteoprotogrin and XRCC3 gene polymorphisms. Results: Mean age in the cases in group A is 63.12 years and in group B was 58.24 years with statistically significant difference between the two groups. The duration of the disease and SBP revealed statistically significant difference between the two groups. The LV mass index and E/A ratio revealed high statistically significant difference between the two groups. OPG sequence revealed no statistically significant difference between the two groups, but XRCC3 sequence revealed statistically significant difference. The age was a risk factor for LVH. Conclusion: Osteoprotogrin and XRCC3 genes polymorphism mutations may be associated with left ventricular hypertrophy in hypertensive patients.

A Case Report of Isolated Left Ventricular Non-Compaction Presenting with Congestive Heart Failure and Intramural Thrombus

Isolated left ventricular non-compaction is recently described as a rare form of cardiomyopathy that is associated with a heart failure, life threatening cardiac arrhythmia and thromboembolic complications. The diagnosis is based on echocardiography demonstration of spongy myocardium. Here we report a case of 74 years old female patient diagnosed as an isolated left ventricular non-compaction with congestive heart failure, intramural thrombus and hypertension. There is no specific treatment for LVNC;therapeutic measures are directed towards the patient’s symptom (heart failure, arrhythmia and thrombotic events) and consideration of an implantable cardioverter defibrillator and cardiac transplantation.

Cardiac resynchronization therapy for heart failure induced by left bundle branch block after transcatheter closure of ventricular septal defect

A 54-year-old female patient with congenital heart disease had a persistent complete left bundle branch block three months after closure by an Amplatzer ventricular septal defect occluder. Nine months later, the patient suffered from chest distress, palpitation, and sweating at daily activities, and her 6-min walk distance decreased significantly （155 m）. Her echocardiography showed increased left ventricular end-diastolic diameter with left ventricular ejection fraction of 37%. Her symptoms reduced significantly one week after received cardiac resynchronization therapy. She had no symptoms at daily activities, and her echo showed left ventricular ejection fraction of 46%and 53%. Moreover, left ventricular end-diastolic diameter decreased 6 and 10 months after cardiac resynchronization therapy, and 6-min walk dis-tance remarkably increased. This case demonstrated that persistent complete left bundle branch block for nine months after transcatheter closure with ventricular septal defect Amplatzer occluder could lead to left ventricular enlargement and a significant decrease in left ventricular systolic function. Cardiac resynchronization therapy decreased left ventricular end-diastolic diameter and increased left ventricular ejection fraction, thereby improving the patient’s heart functions.

Effect of Salvia Miltiorrhiza Bge on Left Ventricular Hypertrophy and the Expression of Tumor Necrosis Factor-α in Spontaneously Hypertensive Rats

The effects of salvia miltiorrhiza Bge (SMB) on left ventricular hypertrophy (LVH) and the expression of tumor necrosis factor-α (TNF-α) in the left ventricle of spontaneously hypertensive rats and the action mechanism were investigated. Normal Wistar-kyoto (WKY) rats were used as negative control, and spontaneously hypertensive rats (SHR) were randomly assigned to receive pla- cebo or SMB. SMB (1 g/kg·d) was injected intraperitoneally for 12 weeks. Systolic blood pressure (SBP) and left ventricular mass index (LVMI) were measured. HE, VG and immunohistochemical staining combined with computed morphometry were employed to evaluate the cardiomyocyte size, diameter, the collagen volume fraction (CVF), perivascular circumferential area (PVCA), and tumor necrosis factor-α (TNF-α) expression in the left ventricular tissue. The results showed, as compared with WKY rats, the SBP, LVMI, cardiomyocyte size, diameter, CVF, PCVA, and TNF-α expression were increased markedly in the 20-week-old spontaneously hypertensive rats. SMB decreased LVMI (P<0.01), size of cardiomyocytes (P<0.01), collagen volume fraction (P<0.01), perivascular circum- ferential area (P<0.01), and TNF-α expression (P<0.01), but had no effect on SBP (P>0.05). It was suggested that chronic administration of SMB could inhibit and reverse the development of LVH in spontaneously hypertensive rats independent of BP. TNF-α may be involved in the reversal mecha- nism of LVH by SMB.

Effect of amlodipine combined with telmisartan or compound amiloride on plasma ET-1 concentration and left ventricular diastolic function of essential hypertension patients with left ventricular hypertrophy

Objective： To observe the effect of different combination antihypertensive therapies on plasma endothelin-1 （ET-1） concentration and left ventricular diastolic function of essential hypertension patients with left ventricular hypertrophy （LVH） Methods： A total of 111 patients with essential hypertension were selected, including 60 cases （34 males, 26 females） aged （60.7±5.6） years with simple hypertension, and 51 cases （28 males, 23 females） aged （61.8±7.0） years with essential hypertension complicated with LVH. Essential hypertension patients with LVH were randomly divided into the group of amlodipine （2.5 mg/d） combined with telmisartan （40 mg/d, n=26） and the group of amlodipine （2.5 mg/d） combined with amiloride （half tablet/d, n=25）,and the treatment lasted for 1 year. Echocardiography was performed before and after the treatment. Left ventricular mass index （LVMI）, left ventricular isovolumic relaxation time （IVRT） and other indicators were detected, and plasma ET-1 concentrations were measured for comparative analysis. And 56 patients （31 males, 25 females） aged （59.3±6.7） years with normal blood pressure in the same period in our hospital were selected as the normal control group. Results： The general clinical characteristics were similar between hypertensive LVH group, simple hypertensive group and normal healthy control group. Plasma ET-1 concentrations, LVMI and IVRT of hypertensive LVH group were significantly higher than those of normal control group and simple hypertension group, and the difference was statistically significant. The patients＇ baseline blood pressure, ET-1, LVMI, interventricular septal thickness （IVST）, left ventricular posterior wall thickness （LVPWT）, left ventricular end-diastolic diameter （LVEDd） and other clinical parameters showed no significant difference （P〉0.05） between the group of amlodipine combined with telmisartan and the group of amlodipine combined with amiloride. It was found that compared with that before treatment, blood pressure could be effectively controlled （P〈0.05）, and LVMI, IVST, LVPWT and IVRT （P〈0.05） were all lowered, and ET-1 （P〈0.01） was significantly reduced after 1 year of antihypertensive therapy in both the group of amlodipine combined with telmisartan and the group of amlodipine combined with amiloride. The group of amlodipine combined with telmisartan was better in lowering blood pressure and reducing LVMI, IVST, LVPWT, IVRT and ET-1 than the group of amlodipine combined with amiloride （P〈0.05）. Conelus｜on： Amlodipine-based combination antthypertensive therapy could reverse LVH and improve left ventricular diastolic function partly by lowering blood pressure and ET-1, and the effect of amlodipine combined with telmisartan was superior to that ofamlodipine combined with amiloride

Arterial hypertension and electrocardiographic diagnosis of left ventricular hypertension in the group of geriatric patients with coronary heart disease living in the far north

As a result of research, high prevalence of arterial hypertension has been identified in the group of patients with coronary heart disease aged 60 and older. Most often, occurring form of arterial hypertension among geriatric patients is isolated systolic arterial hypertension (ISAH). The comparison of two ethnic groups of the population has showed higher levels of systolic and diastolic blood pressure (SBP and DBP) in the group of patients of non-indigenous nationality, rather than Yakut patients. Correlation was recorded in the group of non-indigenous patients as they age. Significant increase in the level of SBP was identified in the group of senile and long-livers than in the elderly. Detection of ECG signs of LVH showed the lowest specificity of Cornell voltage criterion comparing to Sokolow-Lyon criterion with its more often occurrence. ECG-signs of left ventricle hypertrophy are significantly more often established by Sokolow-Lyon criterion for men, Cornell voltage—for women. Correlation has been found between the presence of LVH and combination of Cornell voltage criterion with both Gubner-Ungerleider and Sokolow-Lyon criteria.

Effect of Xinjikang on left ventricular hypertrophy remodeling in hypertensive rats

Objective:To investigate the effects of Xinjikang on the left ventricular hypertrophy remodeling and myocardial activity in hypertension.Methods:Sixty Wistar rats were randomly divided into four groups.The pressure-loaded left ventricular hypertrophy model was established with abdominal aorta ligation method.Rats in A and B groups were intragastrically administered with physiological saline,while C and D groups were administered with Xinjikang and metoprolol,respectively.The changes in blood pressure.E/A ratio,myocardial pathological morphology,myocardial lipoperoxides and superoxide dismustase activity in four groups were observed and compared before and after treatment.Results:There were statistically significant differences in E/A ratio between C group after treatment and model group(P<0.05).while no difference was observed between A and D groups(P>0.05);after treatment the myocardial lipoperoxides and superoxide dismustase contents in C and D groups were improved significantly compared with model group(P<0.05).Conclusions:Xinjikang can improve myocardial injury,restore myocardial parenchyma and myocardial interstitial remodeling functions in hypertensive rats with the left ventricular hypertrophy.

Left ventricular assist devices as destination therapy in stage D heart failure

1 Introduction? Mechanical circulatory support (MCS) has increasingly become an important management opportunity for patients with stage D heart failure (HF) with remarkable impact on patient survival and quality of life. Early clinical trials have demonstrated improved outcomes of durable left ventricular assist device (LVAD) support compared with optimal medical management.[1] As technology advanced, continuous flow LVADs outperformed pulsatile flow devices in clinical trials and the field migrated to HeartMate (Abbott Laboratories, Abbott Park, IL) and HeartWare (Medtronic, Minneapolis, MN) devices due to their clinical superiority. Among the continuous flow devices.

Regional Heterogeneity in 3D Myocardial Shortening in Hypertensive Left Ventricular Hypertrophy: A Cardiovascular CMR Tagging Substudy to the Life Study

Background: Increased relative wall thickness in hypertensive left ventricular hypertrophy (LVH) has been shown by echocardiography to allow preserved shortening at the endocardium despite depressed LV midwall circumferential shortening (MWCS). Depressed MWCS is an adverse prognostic indicator, but whether this finding reflects reduced global or regional LV myocardial function, as assessed by three-dimensional (3D) myocardial strain, is unknown. Methods and Results: Cardiac Magnetic Resonance (CMR) tissue tagging permits direct evaluation of regional 3D intramyocardial strain, independent of LV geometry. We evaluated 21 hypertensive patients with electrocardiographic LVH in the LIFE study and 8 normal controls using 3D MR tagging and echocardiography. Patients had higher MR LV mass than normals (116 ± 40 versus 63 ± 6 g/m2, P = 0.002). Neither echocardiographic fractional shortening (32 ± 6 versus 33% ± 3%), LVEF (63% versus 64%) or mean end-systolic stress (175 ± 27 versus 146 ± 28 g/cm2) were significantly different, yet global MWCS was decreased by both echocardiography (13.4 ± 2.8 versus 18.2% ± 1.5%, P P P = 0.002) in LVH and greater in lateral and anterior regions versus septal and posterior regions ( P P P 0.60, P = 0.001 for both). Conclusions: In patients with hypertensive LVH, despite normal LV function via echocardiography or CMR, CMR intramyocardial tagging show depressed global MWCS while 3D MR strain revealed marked underlying regional heterogeneity of LV dysfunction.

Evolvement of left ventricular assist device： the implications on heart failure management

Heart failure （HF） is a potentially fatal disease that affects increasing number of people worldwide. Although heart transplant is the ＂gold standard＂ therapy for HF, due to the limited availability of organs, many patients died when waiting for the transplant. Left ventricular assist device （LVAD）, as a mechanical circulatory support, has become a new light for patients with HF. With the technical advancements, LVADs work not only as a bridge to transplant, but also assist heart recovery and even as a destination therapy in long-term treatment. This observation paper reviewed the development of LVAD and its clinical roles. The challenges and possible solutions in nursing care for pa- tients with LVAD at different stage of implantation were discussed. The healthcare professionals could obtain a better understanding about the LVAD treatment for HF patients.

Left and right ventricular diastolic dysfunction and diastolic heart failure: does one lead to the other?

Background and Objective Diastolic dysfunction of the left ventricle is a mechanical abnormality diagnosed primarily by echocardiogram, and can be distinguished into three separate degrees based on the severity of reduction in passive compliance and active myocardial relaxation. Methods A literature search was performed for basic science studies, clinical studies and major practice guidelines on the subject of diastolic dysfunction and diastolic heart failure. Important findings were analyzed and correlated with regard to clinical relevance. Results Left ventricular diastolic dysfunction appears to compromise exercise tolerance and is believed to contribute to the pathophysiology in patients with diastolic heart failure. In the clinical setting, however, oftentimes no clear distinction is made between echocardiographically diagnosed diastolic dysfunction and diastolic heart failure, and adequate treatment recommendations are sparse and aimed to prevent worsening and progression of clinical symptoms. To date, there is a lack of high powered trials assessing the possible progression rate from echocardiographically diagnosed diastolic dysfunction to the clinical diagnosis of diastolic heart failure. Furthermore, there are no solid indices to assess the degree of severity of diastolic dysfunction or its progression. Pure right ventricular diastolic dysfunction appears to be even less understood and under-recognized, although it may play a role in the development of both right and left heart failure. Currently there are few but interesting data on the possible interaction between ventricles with diastolic dysfunction and the overall affect on the development of heart failure. Conclusions The timeline and progression of diastolic dysfunction to diastolic heart failure have not been well established and warrant further investigation.