Inclusion Criteria:  adult patients with diagnosed diastolic dysfunction. long term controlled hypertension. Long term controlled diabetes mellitus. Controlled atrial fibrillation. Aged patients above 60 years  Exclusion Criteria:  Patients younger than 18 years. Patients with body mass index (BMI) ˂ 25 and ˃35 wts Major cardiovascular problems with ejection fraction ˂ 40 %. Any implanted mechanical cardiac device