Should We Test for Diastolic Dysfunction? How and How Often?

JACC Cardiovasc Imaging. 2020 Jan;13(1 Pt 2):297-309. doi: 10.1016/j.jcmg.2019.02.029. Epub 2019 Jun 12.


Symptoms of heart failure (HF) are due in large part to elevation of left and/or right ventricular filling pressures. Although abnormal diastolic function is difficult to define, it contributes to the elevation of filling pressures. Tests that characterize aspects of diastolic function or structural changes associated with diastolic dysfunction, may help in establishing a diagnosis of HF, assessing prognosis, and guiding treatments. Individual echocardiographic parameters correlate weakly with LV (LV) filling pressures measured directly. However, a combination of multiple parameters improves accuracy for detection of elevated filling pressures. Serum natriuretic peptide levels are related to ventricular filling pressures and, when elevated, are a key diagnostic criterion for HF. Currently available evidence is not adequate to recommend serial echocardiographic studies or natriuretic peptide level measurements to assess changes in filling pressures or to guide HF therapy. Measurements of inferior vena cava size and dynamics have potential for identifying inadequate decongestion during episodes of acute decompensated HF but have not yet demonstrated utility in improving HF outcomes. Direct measurement of LV filling pressures using implanted pressure sensors is the only "diastolic assessment" thus far that has proven efficacy in reducing HF hospitalization rates.

Keywords: diastolic function; echocardiography; hemodynamics; implantable pressure monitoring; natriuretic peptides.

Publication types

  • Review

MeSH terms

  • Biomarkers / blood
  • Cardiac Catheterization* / instrumentation
  • Cardiac Catheters
  • Diastole
  • Echocardiography*
  • Heart Failure / diagnostic imaging*
  • Heart Failure / physiopathology
  • Heart Failure / therapy
  • Humans
  • Natriuretic Peptides / blood
  • Predictive Value of Tests
  • Prognosis
  • Transducers, Pressure
  • Ventricular Dysfunction, Left / diagnostic imaging*
  • Ventricular Dysfunction, Left / physiopathology
  • Ventricular Dysfunction, Left / therapy
  • Ventricular Function, Left*
  • Ventricular Function, Right
  • Ventricular Pressure


  • Biomarkers
  • Natriuretic Peptides