Diastole, the dark side of the heart cycle, has been recognized as a main topic of pathophysiological and clinical interest. Isolated diastolic heart failure is present in nearly half of symptomatic patients, often accompanies systolic heart dysfunction, and is a prominent cause of hospitalization and mortality. Either a unique nosological entity or the final result of cardiac and extracardiac alterations, diastolic heart failure has long represented a problem of definition, nomenclature, diagnosis, a no-man’s land to be explored. The diagnostic approach to healthy and diseased diastole, by combination of ultrasounds, cardiac biomarkers and advanced imaging, including cardiac magnetic resonance has improved dramatically, but diastole as a therapeutic target is still a central unattended problem. The neuroendocrine interpretative model in systolic heart failure led, by the use of pharmacological and nonpharmacological strategies of neurohormonal antagonism to the improvement of patients’ prognosis, helped by tailored treatment of underlying etiologies, as well as by the use of device implantation. Conversely, attempts for the treatment of “diseased diastole”, either by using the same drug armamentarium applied to systolic failure, or by testing novel rational approaches has up-to-date been unsuccessful. Opinion makers propose that we should think to diastolic heart failure not as a unique phenotype, but rather as a spectrum of diseases, given the diverse etiology, the different degree of impairment, and the eventual presence of comorbidities, claiming for a “precision” approach, which would warrant the best care of the individual patient even with currently available therapies. To discuss all these topics, interventions by experts, as well as by young researchers who will join a dedicated program, will cover all pathophysiologic, diagnostic and therapeutic open questions, in order to prepare “the step forward” needed, to claim for an enhanced effort by the clinical community, with more science, more imagination, and a bit “more heart”, as the basis for future research in the field of diastole disease. Thanks to the Fondazione Menarini, we have the unique chance to meet together in one of the most beautiful cities in Tuscany, in a workshop endorsed by all the University and Research organizations, strongly collaborating to translational research projects in the field. We are sure of the final success of such an initiative, which we do want to be the first of several ones.
Michele Emdin and Stefano Taddei Course Meeting Directors