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Diastolic Dysfunction.

Sean W. Murphy1

  • 1Patient Research Center, Health Sciences Center, 300 Prince Phillip Drive, St. John's, Newfoundland A1B 3V6, Canada. swmurphy@mun.ca

Current Treatment Options in Cardiovascular Medicine
|March 17, 2004
PubMed
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Diastolic dysfunction heart failure, common in North America, has unsatisfactory treatments. Current therapies focus on volume reduction, heart rate control, and managing contributing factors like ischemia and hypertension.

Area of Science:

  • Cardiology
  • Internal Medicine

Background:

  • Heart failure is a major cause of hospital admissions.
  • Diastolic dysfunction affects approximately half of heart failure patients with preserved systolic function.
  • Current therapeutic strategies for diastolic dysfunction are largely empirical and unsatisfactory.

Purpose of the Study:

  • To review current management strategies for diastolic dysfunction.
  • To highlight the limitations of existing therapies and the need for outcome-based trials.
  • To discuss potential therapeutic avenues including renin-angiotensin system blockade and management of contributing factors.

Main Methods:

  • Review of existing literature and clinical trial data on diastolic heart failure management.
  • Analysis of acute and long-term treatment approaches.

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  • Discussion of pharmacological interventions and their evidence base.

    • Main Results:

    • Acute management involves volume reduction (diuretics, nitrates) and heart rate control (beta blockers, calcium channel blockers).
    • The role of digoxin is controversial, with some evidence of symptom improvement and reduced hospitalization.
    • Renin-angiotensin system blockade offers benefits in afterload reduction and left ventricular hypertrophy regression, despite mixed trial results in diastolic heart failure.

    Conclusions:

    • Long-term management requires addressing myocardial ischemia, hypertension, and left ventricular hypertrophy.
    • Further research and outcome-based trials are crucial for developing targeted therapies for diastolic dysfunction.
    • Newer treatments directly targeting pathophysiologic pathways are anticipated.