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Diastolic Heart Failure
1Division of Cardiology, Department of Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 816, PO Box 250625, Charleston, SC 29425-5799, USA. zilem@musc.edu.
Insights
Diastolic heart failure (DHF) is a common cause of heart failure with preserved ejection fraction, affecting up to 50% of patients. Effective management involves targeting symptoms, underlying diseases, and future mechanisms to improve outcomes.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Diastolic heart failure (DHF) is a frequent cause of congestive heart failure (CHF), accounting for 35% to 50% of cases.
- DHF significantly impacts patient mortality and morbidity, with a 5-year mortality rate of 25% to 35% and a 1-year readmission rate of 50%.
Purpose of the Study:
- To outline the diagnostic criteria for DHF, emphasizing symptoms, physical exam findings, and diastolic function.
- To detail current and future therapeutic strategies for DHF, focusing on symptom, disease, and mechanism-targeted approaches.
Main Methods:
- Diagnosis involves identifying CHF symptoms and signs with normal left ventricular volume and ejection fraction.
- Treatment strategies encompass symptom relief, management of causal diseases like ischemia and hypertrophy, and future mechanism-based therapies.
Main Results:
- Abnormal diastolic function confirms DHF but is not mandatory for diagnosis.
- Symptom management includes diuretics, nitrates, heart rate reduction (beta-blockers, calcium channel blockers), and improved exercise tolerance (ACE inhibitors, ARBs).
Conclusions:
- DHF is a prevalent and serious condition requiring multifaceted treatment.
- Future therapies aim to target neurohumoral activation and intracellular pathways for improved patient outcomes.
Abstract:
The diagnosis of diastolic heart failure (DHF) can be made when a patient has both symptoms and signs on physical exam of congestive heart failure (CHF), and normal left ventricular volume and ejection fraction. Documentation of abnormal diastolic function is confirmatory but not mandatory. Diastolic heart failure is a frequent cause of CHF (prevalence is 35% to 50%) and has a significant effect on mortality (5-year mortality rate is 25% to 35%) and morbidity (1-year readmission rate is 50%). Treatment should be targeted at symptoms, causal clinical disease, and underlying basic mechanisms. Symptom-targeted therapy: decrease pulmonary venous pressure using diuretics and long-acting nitrates, maintain atrial contraction and atrial ventricular synchrony, reduce heart rate using beta-adrenergic blockers and calcium channel blockers; increase exercise tolerance by reducing exercise- induced increases in blood pressure and heart rate using angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers, and calcium channel blockers. Disease-targeted therapy: prevent or treat myocardial ischemia, prevent or regress left ventricular hypertrophy. Mechanism-targeted therapy (future directions): modify neurohumoral activation using renin, angiotensin, and aldosterone system antagonists (ACE inhibitors, angiotensin II receptor blockade, aldosterone and renin antagonist); endothelin antagonists; nitric oxide agonists; and atrial natruretic peptide agonists; alter intracellular mechanisms; alter extracellular matrix structures.