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Diastolic heart failure in older people--myth or lost tribe?
1Newcastle University Department of Geriatric Medicine, Sunderland Royal Hospital. john.baxter@chs.northy.nhs.co.uk
Insights
Diastolic dysfunction, a cause of heart failure, presents diagnostic challenges, especially in older adults. Further research is needed to confirm its prevalence and effective treatments.
Area of Science:
- Cardiology
- Heart Failure Research
- Diagnostic Imaging
Background:
- Left ventricular diastolic dysfunction involves impaired myocardial relaxation and reduced compliance.
- Diastolic congestive heart failure (CHF) diagnosis is debated, with potential overdiagnosis in elderly patients.
- Echocardiographic findings of diastolic dysfunction can be present in normal aging hearts.
Purpose of the Study:
- To address the controversy surrounding the diagnosis of diastolic CHF.
- To evaluate the prevalence of diastolic dysfunction in symptomatic older adults.
- To highlight the lack of disease-modifying treatments for diastolic CHF compared to systolic CHF.
Main Methods:
- Review of existing studies on diastolic dysfunction and CHF.
- Analysis of echocardiographic findings in symptomatic older individuals.
- Examination of current clinical trial data for relevant treatments.
Main Results:
- Up to one-third of older symptomatic CHF patients show echocardiographic evidence of diastolic dysfunction.
- Comorbid conditions in patients may be misattributed as diastolic CHF.
- Characteristic echocardiographic features of diastolic dysfunction can be a normal finding in aging hearts.
Conclusions:
- The diagnosis of diastolic CHF remains controversial, with potential for misdiagnosis.
- Evidence for disease-modifying treatments for diastolic CHF is currently lacking.
- Ongoing clinical trials may clarify the prognosis and management of diastolic CHF.
Abstract:
Left ventricular diastolic dysfunction occurs due to a variable combination of abnormal myocardial relaxation and reduced ventricular compliance. The diagnosis of diastolic congestive heart failure is controversial. Some studies suggest that up to one-third of older people with symptomatic congestive heart failure (CHF) have echocardiograph evidence of diastolic dysfunction. Other authors have suggested the comorbid diseases often found in persons with suspected diastolic CHF explain the patient's symptoms and hence diastolic CHF is a misdiagnosis in many cases. Many of the characteristic echo features of diastolic dysfunction occur in normal ageing hearts. Unlike in systolic CHF, evidence for disease modifying treatment is lacking. Clinical trials currently in progress to determine the effectiveness of ACE inhibitors and angiotensin II receptor antagonists in the management of diastolic CHF may clarify the prognosis and management of this condition.