Heart Failure Reviews, 5, 333±336, 2000 # 2000 Kluwer Academic Publishers. Manufactured in The Netherlands LV Hypertrophy and Diastolic Heart Failure Sandro Betocchi, MD, FESC, FACC 1 , Otto M. Hess, MD, FESC 2 1 Department of Clinical Medicine, Cardiovascular and Immunological Sciences, Federico II University of Naples, Italy, and 2 Swiss Cardiovascular Center, Bern University Hospital, Switzerland De®nition The current de®nition of heart failure is rather complex: `Heart (or cardiac) failure is the patho- physiological state in which the heart is unable to pump blood at a rate commensurate with the requirements of the metabolizing tissues or can do so only from an elevated ®lling pressure' [1]. Such a complexity stems from the need to include under the same roof very diverse conditions: a. Systolic heart failure (inability of the heart to pump enough blood) b. Increased requirements of the metabolizing tissues (the heart pumps a normal amount of blood, but this amount is not enough because the tissues' need is increased) c. Diastolic heart failure (the heart pumps enough blood, but to do so it requires abnor- mally elevated ®lling pressures). According to this de®nition, diastolic heart failure is the condition in which, because of pathophysiological changes of the heart, a normal cardiac output is achieved only at ®lling pressures so elevated to cause symptoms of heart failure. The European Study Group On Diastolic Heart Failure, an ad hoc subcommittee of the Working Group on Myocardial Function of the European Society of Cardiology, has suggested that the following conditions be simultaneously present to identity diastolic heart failure [2]: a. Signs or symptoms of congestive heart failure i. Exertional dyspnea and=or reduced peak O 2 consumption (<25 ml  kg 1  min 1 ), orthopnea, ii. Gallop sounds, lung crepitations, pulmon- ary oedema b. Normal or mildly reduced left ventricular systolic function i. Normal left ventricular performance (ejec- tion fraction  45%) ii. Left ventricular dilatation (end-diastolic diameter index <3.2 cm  m 2 or end-dia- stolic volume index <102 ml  m 2 ) c. Evidence of abnormal left ventricular relaxa- tion, ®lling, diastolic distensibility and diasto- lic stiffness A normal (or nearly normal) left ventricular systolic function should be assessed at the time when signs and=or symptoms of heart failure are detected: this is to rule out the possibility that heart failure be the consequence of temporary left ventricular systolic dysfunction, such the one that can occur during ischemia of a sizable part of the left ventricle [3]. Epidemiology Heart failure is a common ailment, which is rapidly increasing in its prevalence in af¯uent countries. In the general population of any age, the prevalence of heart failure can be estimated about 1% [4]: while it is very uncommon under 45 y of age, its prevalence approximately doubles each decade, to reach about 10% above 80 y of age. The prevalence of diastolic heart failure is also strongly dependent on age: of all patients with heart failure younger that 60 y, only 6% have diastolic heart failure. This ®gure rises to 21% in patients aged 61 to 70y, and to 41% in those older that 70 y [5]. These data suggest that diastolic heart failure is a geriatric disease; another study in old patients with congestive heart failure (mean age 84 y) shows that systolic function was normal in about half of the patients [6]. 333 Address for correspondence: Prof. Sandro Betocchi, Diparti- mento di Medicina Clinica, Scienze Cardiovascolari ed Immu- nologiche, Universita  di Napoli Federico II, Via S. Pansini, 5-I- 80131 Naples, Italy. E-mail: betocchi@unina.it