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Heart Failure with Normal Ejection Fraction
Mauro Ortiz1, Gregory L. Freeman
1Division of Cardiology, University of Texas Heath Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA. freeman@uthscsa.edu
Insights
Diastolic heart failure, characterized by impaired left ventricular filling, poses significant challenges. Current treatments focus on managing blood pressure, volume, heart rate, and improving ventricular relaxation, with ongoing research into novel therapies.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Diastolic heart failure (DHF), or heart failure with normal ejection fraction, is a prevalent condition.
- It stems from increased left ventricular stiffness and impaired relaxation, leading to pulmonary congestion.
Purpose of the Study:
- To outline the pathophysiology, common causes, diagnostic approaches, and treatment strategies for DHF.
- To highlight areas for future therapeutic development.
Main Methods:
- Review of pathophysiologic mechanisms in DHF.
- Identification of common clinical disorders associated with DHF.
- Summary of current and potential treatment goals and modalities.
Main Results:
- DHF is linked to hypertension, coronary artery disease, hypertrophic cardiomyopathy, and aortic stenosis.
- Treatment involves blood pressure control, volume management, heart rate regulation, and enhancing ventricular relaxation.
- Advanced glycation end-product lysis is a potential future therapy.
Conclusions:
- Effective management of DHF requires a multi-faceted approach targeting specific pathophysiologic aspects.
- Further research is crucial for developing targeted therapies to improve outcomes and reduce treatment failure in DHF.
Abstract:
Heart failure with normal ejection fraction, also known as diastolic heart failure, is a major problem for patients and health-care providers and is a substantial expense to society. The main pathophysiologic processes involved are increased left ventricular stiffness and abnormal relaxation, with resulting impaired left ventricular filling. These processes typically displace the pressure-volume relationship in an upward direction, resulting in increased left ventricular end-diastolic, left atrial, and pulmonary capillary wedge pressures, leading to symptoms of pulmonary congestion. The most common clinical disorders leading to diastolic heart failure are 1) hypertension with concentric left ventricular hypertrophy, 2) coronary artery disease with decreased left ventricular compliance, 3) hypertrophic cardiomyopathy, and 4) aortic stenosis with concentric left ventricular hypertrophy. Echocardiography and cardiac catheterization with magnetic resonance imaging hold promise as future diagnostic tools. The approach to the treatment of diastolic heart failure is focused on four treatment goals: 1) persistent control of elevated blood pressure, with regression of left ventricular hypertrophy, 2) careful reduction of central blood volume (diuretics), 3) maintenance of atrial contraction and control of heart rate (beta-blockers, digoxin, atrioventricular pacing); and 4) improvement of left ventricular relaxation. There is currently no drug treatment specific for abnormal relaxation, although efforts are being made to develop such compounds. A promising future therapy includes agents that lyse advanced glycation end-products as an approach to relieving increased ventricular stiffness. In addition to pharmacotherapy, maintaining ideal body weight and a regular exercise program are also helpful in the treatment of diastolic heart failure. Although the overall prognosis of patients with diastolic dysfunction is more favorable than that of patients with systolic dysfunction, the frequency of treatment failure and recurrent symptoms underscores the need for further improvement in treatment of this condition.