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[Heart failure due to diastolic dysfunction: the treatment principles].
B Pinamonti1, A di Lenarda, G Sinagra
1Unità Operativa di Cardiologia, Ospedale Maggiore, Azienda Ospedaliera Ospedali Riuniti, Trieste.
Summary
Heart failure with preserved ejection fraction often involves diastolic dysfunction. Current treatments focus on symptom control, but more research is needed for optimal therapy in diastolic heart failure.
Area of Science:
- Cardiology
- Heart Failure Pathophysiology
- Diastolic Dysfunction
Context:
- Diastolic dysfunction is increasingly recognized as a significant factor in heart failure.
- Heart failure symptoms and exercise tolerance correlate more closely with diastolic than systolic function.
- Existing heart failure treatment trials primarily focus on systolic dysfunction.
Purpose:
- To review the rationale and therapeutic strategies for managing heart failure stemming from diastolic dysfunction.
- To assess current treatment options and their efficacy for diastolic heart failure.
- To highlight the need for further research into optimal therapies.
Summary:
- Diastolic dysfunction can occur independently or alongside systolic dysfunction.
- Several common heart failure medications may improve diastolic function and prognosis.
- Management aims to reduce left ventricular filling pressures without compromising cardiac output.
Impact:
- Current guidelines recommend diuretics and nitrates for symptomatic relief in preserved systolic function heart failure.
- Beta-blockers, calcium antagonists, and ACE inhibitors show potential but require more evidence.
- Addressing underlying causes like ischemia, hypertension, and arrhythmias is crucial for effective treatment.