Assessment of diastolic function: How much more evidence do we need?

Diastolic dysfunction (DD) usually reflects impaired left ventricular (LV) relaxation and increased LV chamber stiffness, leading to increased filling pressures. 1t may relate to altered LV geometry, myocardial stiffness and fibrosis, molecular mechanisms underlying delayed myocardial relaxation and tone, and disturbed ventriculararterial coupling. 2D may manifest as altered diastolic suction and filling, mitral annular movements, myocardial strain patterns, torsional movements, LV synchrony, and left atrial (LA) size and function. 2here is increasing evidence documenting the association of DD with aging, 3 cardiovascular risk factors (diabetes and pre-diabetes, hypertension and pre-hypertension, and obesity), 4,5 and various comorbidities, including coronary artery disease and end-stage kidney disease. 6,7DD is also a known contributor to clinical heart failure in patients with reduced LV ejection fraction (LVEF), and plays a central role in heart failure with preserved LVEF. 2,8he association of DD with prognosis is the subject of increasing interest, with a large body of accumulating evidence.