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Related Experiment Videos

Diastolic dysfunction and atrial fibrillation.

Rangadham Nagarakanti1, Michael Ezekowitz

  • 1Lankenau Institute for Medical Research, 100 Lancaster Avenue, Wynnewood, PA 19096, USA.

Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing
|February 12, 2008
PubMed
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Diastolic dysfunction (DD) in heart failure with preserved ejection fraction (HFpEF) is diagnosed using echocardiography. Treatments for HFpEF and prevention of atrial fibrillation (AF) are evolving.

Area of Science:

  • Cardiology
  • Echocardiography
  • Heart Failure Research

Background:

  • Diastolic heart failure (DHF) affects 30-50% of heart failure patients with preserved left ventricular (LV) systolic function.
  • DHF is characterized by diastolic dysfunction (DD), involving impaired LV relaxation or distensibility.
  • DHF is an independent predictor of atrial fibrillation (AF) in the elderly.

Purpose of the Study:

  • To describe the diagnosis of diastolic dysfunction (DD) in both sinus rhythm and atrial fibrillation (AF).
  • To report on therapeutic agents for diastolic heart failure (DHF) and AF prevention in DHF patients.

Main Methods:

  • Diagnosis of DD in sinus rhythm utilizes Doppler mitral inflow measurements (E/A ratio, deceleration time, isovolumic relaxation period) and tissue Doppler (E/E' ratio).

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  • Pulmonary vein measurements are used to unmask pseudonormal filling patterns in moderate DD.
  • Diagnosis of DD in AF relies on measurements independent of atrial contraction, such as deceleration time and E/E' ratio.

    • Main Results:

    • Echocardiographic criteria differentiate early, moderate, and restrictive DD based on specific Doppler and tissue Doppler parameters.
    • Angiotensin receptor blockers (ARBs) have demonstrated a decrease in AF incidence in DHF patients.
    • Ongoing trials are evaluating agents like Irbesartan and spironolactone for DHF treatment.

    Conclusions:

    • Echocardiography is crucial for diagnosing DD in patients with DHF, irrespective of heart rhythm (sinus rhythm or AF).
    • Randomized controlled trials for DHF are ongoing.
    • Therapeutic strategies for DHF and AF prevention continue to advance.