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[Diastolic heart failure. Physiopathology]
A Cohen Solal1, E Salengro, P Garçon
1Service de Cardiologie, Hôpital Beaujon, 100, boulevard du Général Lederc, 92118 Clichy.
Background:
Systolic dysfunction of the left ventricle is not the only mechanism of heart failure. An increasing number of patients are found to have heart failure with an ejection fraction > or = 40%. The proportion of heart failure patients with "diastolic" (or more appropriately preserved systolic function) heart failure increases with age. This clinical entity currently accounts for 30 to 40% of all hospitalizations for heart failure and in patients over 80 is found in more patients than is systolic dysfunction.
Pathophysiology:
Diastolic heart failure generally associates prolonged ventricular relaxation with reduced left ventricular capacity for distention. The main causes are ischemic, hypertensive and age-related heart disease. Concentric remodeling of the left ventricle, with or without hypertrophy, always leads to diastolic functional disorders. A triggering factor is almost always found for episodes of acute congestion.
Conclusion:
The incidence of "diastolic" heart failure increases with age. Physicians should be aware of the complex underlying pathophysiological mechanisms.