Difference Between Systolic and Diastolic Heart Failure

There are two types of heart failure that impact the left side of your heart. These are known as systolic and diastolic heart failure. If you have been diagnosed with left ventricle or left-sided heart failure, it is a good time to educate yourself more about what these terms mean and how it can make a difference in how you take care of yourself after the diagnosis. Here’s everything you need to know to help you understand the difference between systolic and diastolic heart failure.

Difference Between Systolic and Diastolic Heart Failure

Heart failure is a medical condition that happens when the heart fails to pump blood efficiently enough to keep the body healthy.(1,2,3) The heart may eventually start pumping even less efficient when you are feeling stressed or doing some physical activity. There are two types of heart failure that affect the left side of your heart, known as systolic and diastolic heart failure. If you have systolic heart failure, it means your heart is unable to contract properly during the heartbeats. On the other hand, diastolic heart failure means the heart is unable to relax normally between the heartbeats.(4,5) If you have either type of left-sided heart failure, it increases the risk of having right-sided heart failure.

Diagnosing and managing these two different types of heart failure come with some similarities, while some things are going to be different.(6)

Let’s take a look.

How is Systolic Heart Failure Diagnosed?

Systolic heart failure occurs when the left side or left ventricle of your heart is not able to contract properly or entirely. This means that your heart is not able to pump blood with enough force that will move the blood throughout the body as it should normally be doing.

Systolic heart failure is also known as heart failure with reduced ejection fraction, or HFrEF.

Ejection fraction is a term used for the measurement of how much blood is leaving the heart ventricle every time the heart pumps. The more the heart is pumping out, the healthier your heart is, and the higher will be the ejection fraction.(7)

Your doctor will tell you what your ejection fraction is in a percentage after your imaging tests have been done, such as an echocardiogram (ECG). An ejection fraction of 50 to 70 percent is considered to be normal.(8) However, it is still possible to have a different type of heart failure, even when your ejection fraction is normal.(9)

An ejection fraction of under 40 percent means you have a decreased ejection fraction, and it is usually an indication that you have systolic heart failure.

How is Diastolic Heart Failure Diagnosed?

Diastolic heart failure happens when the left ventricle of your heart is no longer able to relax between the heartbeats. This usually happens because the tissues have become stiff. When the heart is unable to relax completely, it will not fill up with blood again before the next heartbeat.(10)

Diastolic heart failure is also known as preserved ejection fraction (HFpEF). When a person has this type of heart failure, the doctor will do an imaging test on the heart to determine what is your ejection fraction. Your doctor will also take into consideration whether you are experiencing any other symptoms of heart failure and if there is any other evidence to indicate that your heart is not functioning properly. If these criteria are met, you will be diagnosed with diastolic heart failure.

Diastolic heart failure typically affects older women and tends to occur alongside other types of heart disease. Other non-heart related conditions such as lung disease and cancer can also increase the risk of having diastolic heart failure.(11)

Treating Systolic Heart Failure with Medications

There are numerous medications that your doctor may prescribe for treating systolic heart failure. These include:

  • Beta-blockers (BBs)
  • Angiotensin receptor blockers (ARBs)
  • Angiotensin receptor-neprilysin (ARN) inhibitors
  • Angiotensin-converting enzyme (ACE) inhibitors
  • Mineralocorticoid receptor antagonists (MRAs)
  • Diuretics
  • Digoxin
  • F-channel blockers
  • Inotropes

While for some, one type of medication itself is useful, but for most people, a combination of these treatments prove to be effective.

For example, in 2015, the US Food and Drug Administration (FDA) designated a medication that combines sacubitril, which is an ARN inhibitor, and valsartan, which is an ARB, as a ‘first-in-class’ novel treatment for heart failure.(12) The FDA designates any type of new medication as first-in-class when not only is it innovative, but it also works in a different way than the previous treatment options.

A 2017 review looked at 57 clinical trials that involved a variety of combination treatments for heart failure. The study found that people who were taking a combination of beta-blockers, ACE inhibitors, and MRAs had a 56 percent lesser risk of dying due to systolic heart failure, as compared to people who were given a placebo. Those who were given a combination of beta-blockers, MRAs, and ARN inhibitors had a 63 percent lower death rate as compared to people who were given a placebo during the trial.(13)

Treating Diastolic Heart Failure with Medications

Many doctors may treat diastolic heart failure with many of the same medications that are used for treating systolic heart failure. However, diastolic heart failure is not well understood, and there is a lack of research on this as well. This means that doctors do not have the same guidelines for what can be the most effective treatment for diastolic heart failure.

Here are some of the primary approaches used for treating diastolic heart failure with medications:

  • Medications That Help Widen Or Relax The Blood Vessels: Such medicines may include beta-blockers, calcium channel blockers, ARBs, or long-acting nitrates. Doctors may also use vasodilators like nitroglycerin.
  • Medications For Controlling Or Treating Other Underlying Conditions: Treatment may also focus on managing and treating other medical conditions like high blood pressure, which is known to have a huge effect on diastolic heart failure.(14)
  • Medications To Decrease Fluid Accumulation: Diuretics, sometimes also referred to as ‘fluid pills,’ can be prescribed to help your body get rid of the excess fluid that has built up.(15)

Other Treatments for Systolic and Diastolic Heart Failure

Implanted Devices

In some people who have either systolic or diastolic heart failure, a device may need to be surgically implanted to help improve heart function. There are various types of such devices that are implanted. These include:

  • Left Ventricular Assist Device (LVAD): This is a pump-like device that is also known as a bridge to transplant. This device helps the left ventricle to perform its job correctly when it is no longer functioning as it should be. This device also helps a person while they are waiting to get a heart transplant.(16)
  • Implantable Cardioverter Defibrillator (ICD): If you have heart failure along with irregular heartbeats, this device will keep giving your heart a shock whenever the heartbeat falls out of rhythm. This will help your heartbeat properly and in rhythm again.(17)
  • Cardiac Resynchronization Therapy (CRT): This is a type of special pacemaker that helps the ventricles of the heart is contracting normally and in the correct rhythm.(18)

Surgery

In some cases, surgery might be recommended for treating systolic or diastolic heart failure. There are two main types of surgery used to treat left-sided heart failure, including:

  • Corrective Surgery: If there is a problem with your heart that is leading to heart failure or worsening an already existing heart condition, you may need to get surgery to fix it. Examples of such types of corrective surgery include a coronary artery bypass and valve replacement surgery. A valve replacement surgery corrects the heart valve that is not working properly, while a coronary artery bypass reroutes blood around the blocked artery that is causing heart failure.
  • Heart Transplant: In severe cases where the heart failure has progressed to a very serious condition, you may need to get a new heart from a donor. After undergoing a heart transplant surgery, you will need to take medications to ensure that your body does not reject the new heart.

Conclusion

If you have been diagnosed with either systolic or diastolic heart failure, you should talk to your doctor to find out what type of heart failure you have so that you can better understand your condition. Understanding whether you have systolic or diastolic heart failure will help you understand the treatment options your doctor discuss with you. Following the treatment plan and taking your medications as your doctor prescribes are the best ways to manage your condition and prevent it from worsening. It also reduces the risk of complications.

References:

  1. Kannel, W.B. and Belanger, A.J., 1991. Epidemiology of heart failure. American heart journal, 121(3), pp.951-957.
  2. Cowie, M.R., Mosterd, A., Wood, D.A., Deckers, J.W., Poole-Wilson, P.A., Sutton, G. and Grobbee, D., 1997. The epidemiology of heart failure. European heart journal, 18(2), pp.208-225.
  3. Roger, V.L., 2013. Epidemiology of heart failure. Circulation research, 113(6), pp.646-659.
  4. Bursi, F., Weston, S.A., Redfield, M.M., Jacobsen, S.J., Pakhomov, S., Nkomo, V.T., Meverden, R.A. and Roger, V.L., 2006. Systolic and diastolic heart failure in the community. Jama, 296(18), pp.2209-2216.
  5. Loek van Heerebeek, M.D., Borbély, A., Niessen, H.W., Bronzwaer, J.G., Van Der Velden, J., Stienen, G.J., Linke, W.A., Laarman, G.J. and Paulus, W.J., 2006. Myocardial structure and function differ in systolic and diastolic heart failure. Circulation, 113, pp.1966-1973.
  6. Chatterjee, K. and Massie, B., 2007. Systolic and diastolic heart failure: differences and similarities. Journal of cardiac failure, 13(7), pp.569-576. Meyer, P., Filippatos, G.S., Ahmed, M.I., Iskandrian, A.E., Bittner, V., Perry, G.J., White, M., Aban, I.B., Mujib, M., Dell’Italia, L.J. and Ahmed, A., 2010. Effects of right ventricular ejection fraction on outcomes in chronic systolic heart failure. Circulation, 121(2), p.252.
  7. www.heart.org. 2020. Ejection Fraction Heart Failure Measurement. [online] Available at: <https://www.heart.org/en/health-topics/heart-failure/diagnosing-heart-failure/ejection-fraction-heart-failure-measurement> [Accessed 12 December 2020].
  8. Sanderson, J.E., 2007. Heart failure with a normal ejection fraction. Heart, 93(2), pp.155-158.
  9. Mandinov, L., Eberli, F.R., Seiler, C. and Hess, O.M., 2000. Diastolic heart failure. Cardiovascular research, 45(4), pp.813-825.
  10. Gary, R., 2006. Exercise self-efficacy in older women with diastolic heart failure: results of a walking program and education intervention. Journal of gerontological nursing, 32(7), pp.31-39.
  11. U.S. Food and Drug Administration. 2020. Novel Drugs Summary 2015. [online] Available at: <https://www.fda.gov/drugs/developmentapprovalprocess/druginnovation/ucm474696.htm> [Accessed 12 December 2020].
  12. Burnett, H., Earley, A., Voors, A.A., Senni, M., McMurray, J.J., Deschaseaux, C. and Cope, S., 2017. Thirty years of evidence on the efficacy of drug treatments for chronic heart failure with reduced ejection fraction: a network meta-analysis. Circulation: Heart Failure, 10(1), p.e003529.
  13. Owan, T.E. and Redfield, M.M., 2005. Epidemiology of diastolic heart failure. Progress in cardiovascular diseases, 47(5), pp.320-332.
  14. Martens, P. and Mullens, W., 2018. How to tackle congestion in acute heart failure. The Korean Journal of Internal Medicine, 33(3), p.462.
  15. Rose, E.A., Gelijns, A.C., Moskowitz, A.J., Heitjan, D.F., Stevenson, L.W., Dembitsky, W., Long, J.W., Ascheim, D.D., Tierney, A.R., Levitan, R.G. and Watson, J.T., 2001. Long-term use of a left ventricular assist device for end-stage heart failure. New England Journal of Medicine, 345(20), pp.1435-1443.
  16. Winkle, R.A., Mead, R.H., Ruder, M.A., Gaudiani, V.A., Smith, N.A., Buch, W.S., Schmidt, P. and Shipman, T., 1989. Long-term outcome with the automatic implantable cardioverter-defibrillator. Journal of the American College of Cardiology, 13(6), pp.1353-1361.
  17. Abraham, W.T. and Hayes, D.L., 2003. Cardiac resynchronization therapy for heart failure. Circulation, 108(21), pp.2596-2603.

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