Diagnosing Diastolic Dysfunction

Diastolic dysfunction occurs when the heart has a hard time relaxing between each beat. This causes restricted blood pumping and increased pressure, which leads to diastolic heart failure (also known as heart failure with preserved ejection fraction, or HFpEF).

Many factors affect a person’s risk for diastolic dysfunction, like their age and chronic conditions like high blood pressure. Some studies have suggested there could be a connection between anxiety and diastolic dysfunction, though the link may not be a direct one.

Early diagnosis and treatment are key for managing the condition, but not everyone has symptoms in the first stages of diastolic dysfunction. Even people who do have symptoms may have normal findings on diagnostic tests, which can make it hard to catch the condition early.

This article covers the tests used to diagnose diastolic dysfunction and decide on treatment. It also explains possible complications of the condition, like diastolic heart failure.

Who Is at Risk for Diastolic Dysfunction?

Some risk factors can make people more likely to develop diastolic dysfunction. Overall, high blood pressure is a leading cause of diastolic dysfunction. Having high blood pressure during pregnancy, including preeclampsia, also raises a person’s risk for diastolic dysfunction.

These are a few other known risk factors for diastolic dysfunction:

• Older age (especially people after menopause)
• High cholesterol and triglyceride levels
• Smoking (especially for females)
• Diabetes (especially for males)
• Obesity
  
• Liver-related conditions (such as fatty liver disease)

Can Anxiety Cause Diastolic Dysfunction?

Some studies suggest that there could be an indirect connection between anxiety and diastolic dysfunction.

For example, one study found that people who reported emotional eating to deal with stress and anxiety had a higher risk of diastolic dysfunction.

Some studies have found that young adults with anxiety and stress are more likely to have diastolic dysfunction. However, other studies have not found a link between anxiety and diastolic dysfunction, though some of them noticed a link between diastolic dysfunction and depression.

Since these studies were small and limited, more research is needed to see if there’s a clear link between anxiety and diastolic dysfunction, as well as to clarify whether it’s a direct or indirect link.

Symptoms

Diastolic dysfunction tends to come on gradually. Some people start having classic symptoms of heart failure as the condition progresses.

People with diastolic dysfunction may have other symptoms, such as:

• Dyspnea (shortness of breath)
• Labored breathing during exercise that gets progressively worse
• Difficulty breathing while lying down
• Difficulty breathing while sleeping
• A chronic cough
• Excessive fatigue
• Unusual weight gain
• Edema (swelling) of the legs and ankles
• Fast or irregular heartbeat (arrhythmia)

You can have any combination of these symptoms with diastolic dysfunction, and some may affect you more than others.

There's no home test for diastolic dysfunction, so you will need to see a healthcare provider to find out if it is the cause of your symptoms.

B-Type Natriuretic Peptide (BNP) Blood Test

B-type natriuretic peptide (BNP) is a molecule released into the blood by heart cells in response to elevated pressure in the heart. BNP causes the kidneys to excrete sodium and water, which lowers the pressure in the blood vessels and heart. BNP is measured with a blood test and can be elevated in diastolic dysfunction.

There is a gray zone between a normal and abnormal BNP level, so the test is not a reliable indicator of heart failure by itself. Sometimes, a BNP blood test is used with other tests to support a diagnosis of diastolic dysfunction.

Imaging Tests

Imaging tests help providers diagnose diastolic dysfunction and determine how serious the condition is.

Echocardiogram

An echocardiogram (echo) is a special, non-invasive ultrasound that shows the heart while it’s moving. Echos show how well the heart muscle and valves are working and can assess diastolic relaxation and the degree of left ventricular stiffness.

An echocardiogram can also reveal conditions that could be causing diastolic dysfunction, such as:

• Ventricular hypertrophy (a thickened left ventricular muscle associated with hypertension and hypertrophic cardiomyopathy)
• Aortic stenosis (narrowing of the valve in the aorta, the largest blood vessel branching off the heart)
• Restrictive cardiomyopathy (when the walls of the lower chambers of the heart are too rigid to expand as they fill with blood)

Left Ventricular Ejection Fraction (LVEF)

An echocardiogram can measure left ventricular ejection fraction (LVEF), which is the percentage of blood the left ventricle of the heart can pump out with each beat.

A normal LVEF is greater than 50%, which means the left ventricle can pump out more than half of the blood that's inside it.

Usually, heart failure is associated with a low LVEF, which reflects the heart's ability to eject blood with a strong pumping action (systolic function). However, some people with diastolic heart failure have normal systolic function and a normal left ventricular ejection fraction.

Electrocardiogram (ECG, EKG)

An electrocardiogram (ECG) is a noninvasive test that shows the electrical system of the heart. During the test, flat metal discs (electrodes) are placed in certain places on your chest, arms, and legs.

The electrodes are attached to a machine that reads the electrical charges generated by each heartbeat. The test takes about five minutes, and the information is graphed as wave patterns that a provider can read.

Cardiac Magnetic Resonance Imaging

Cardiac MRI uses a powerful magnetic field, radio waves, and a computer to make detailed pictures of the structures inside and around the heart. A cardiac MRI can tell a provider a lot about how much strain the heart is under, as well as check for deformation, left atrial size, and trans-mitral blood flow.

The test makes high-contrast and high-resolution images by mapping radio wave signals absorbed and emitted by hydrogen nuclei (protons) in a powerful magnetic field. However, this test is not widely used because it’s very expensive.

Nuclear Imaging

Imaging tests such as the positron emission test (PET) and single-photon emission computerized tomography (SPECT) are sometimes used to identify diastolic dysfunction before symptoms start.

These tests involve getting injected with radioactive dyes (radiotracers). The heart's absorption of the tracers depends on how well it is working. The color changes show whether the muscles of the heart are pumping as well as they should be.

Cardiac Stress Test

A cardiac stress test (cardiac exercise test) measures the heart's response to physical exertion in a controlled setting. It involves walking on a treadmill or pedaling a stationary bike for about 20 minutes. During the test, your blood oxygen level, heart rhythm, pulse, and blood pressure are monitored.

Several types of stress tests can be used to diagnose diastolic dysfunction and heart failure, including:

• Electrocardiogram stress test: For this test, electrode patches are placed on your chest to measure the electrical signals triggered by your heart while you're exercising.
• Echocardiogram stress tests (or echo or cardio ultrasound): For this test, sound waves create a moving picture of how the chambers and valves of your heart function when they are under stress. It can show reduced blood flow, dead muscle tissue, and areas of the heart muscle wall that are not contracting well or may not be getting enough blood.
• Nuclear stress tests: For this test, radioactive dye is injected into the bloodstream to highlight blood flow. The pictures show how much dye has reached different parts of your heart during exercise and at rest.
• Multiple gated acquisition (MUGA) scan: This test uses radionuclide ventriculography (RVG) or radionuclide angiography (RNA) to make a computerized image of your beating heart and the pumping function of the left and right ventricles. It is useful for reading the overall pumping ability of the heart.
• Chemical stress tests: During this test, a medication such as regadenoson, dobutamine, or adenosine is injected into your bloodstream to stress your heart.

Other Tests

A few other tests can also be used to diagnose diastolic dysfunction, and they focus on the performance of the heart and lungs.

Cardiac Catheterization

Cardiac catheterization is an invasive procedure where a long, thin, flexible tube is inserted into your arm or groin and guided into the blood vessels in your heart. The dye is injected into blood vessels so they can be watched using an X-ray or ultrasound.

Cardiac catheterization can show problems with how the heart relaxes and if the ventricles are not relaxing and filling normally.

Testing for inflammatory biomarkers called cytokines along with cardiac catheterization can also help diagnose certain types of diastolic dysfunction and predict whether it will progress to diastolic heart failure.

One study showed that high levels of interleukin-17 and interleukin-6 biomarkers were linked with poorer survival rates and life expectancy for people with diastolic heart failure.

Spirometry

A spirometry test measures lung function, which is often not adequate in people with heart failure. The test involves breathing into a tube attached to a spirometer device that measures how forcefully a person can push air out of their lungs.

Chest X-Ray

A chest X-ray can show if the heart is bigger than normal (enlarged) or if there are signs of congestion in the lungs.

Diastolic Dysfunction Complications

A main complication of diastolic dysfunction is that it can progress to diastolic heart failure. Other complications of diastolic dysfunction include:

• Pulmonary hypertension (a serious and chronic lung condition)
• Sudden cardiac death (due to fatal arrhythmias)
• Worsening renal (kidney) failure (in people with chronic kidney disease)

Summary

Diastolic dysfunction is common, but many people with the disease never have symptoms, so it can be hard to diagnose. Even people who do have symptoms, like shortness of breath, may write them off as signs of "normal aging.” Early diagnosis and treatment of diastolic dysfunction are key. Even though there’s no cure, there are steps you can take to slow the progression of diastolic dysfunction and try to prevent complications like heart failure.