Diastolic dysfunction in the elderly--the interstitial issue.

Area of Science:

• Cardiology
• Pathology
• Pharmacology

Background:

• Diastolic dysfunction is a significant cause of congestive heart failure, particularly in older adults and women.
• A substantial percentage of heart failure patients exhibit preserved left ventricular systolic function.
• Aging contributes to interstitial fibrosis in the heart, impairing diastolic function.

Purpose of the Study:

• To explore the role of interstitial collagen and the renin-angiotensin-aldosterone system in diastolic dysfunction.
• To investigate the potential of targeting this pathway for therapeutic benefit.

Main Methods:

• Histopathologic evaluation of myocardial tissue to assess interstitial collagen.
• Analysis of neurohumoral abnormalities, including renin-angiotensin-aldosterone system activation.
• Review of recent animal and human studies on therapeutic interventions.

Main Results:

• Aging leads to increased interstitial collagen, compromising early diastolic suction and increasing diastolic pressures.
• Activation of the renin-angiotensin-aldosterone system, particularly aldosterone, promotes myocardial fibrosis.
• Inhibition of this system has shown regression of fibrosis and improved diastolic function.

Conclusions:

• Left ventricular diastolic dysfunction is linked to maladaptive interstitial remodeling and fibrosis.
• The renin-angiotensin-aldosterone system plays a key role in the pathogenesis of diastolic dysfunction.
• Targeting this system offers a promising therapeutic strategy for diastolic heart failure.