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[Underestimated--diastolic heart failure in elderly patients]
1Geriatrische Klinik, Klinikum Bayreuth.
Insights
Diastolic heart failure is common in elderly patients, often missed due to normal left ventricular size and systolic function. Early detection of diastolic dysfunction is crucial for appropriate treatment in geriatric care.
Area of Science:
- Cardiology
- Geriatrics
- Internal Medicine
Background:
- Aging leads to diastolic left ventricular (LV) dysfunction, characterized by increased stiffness and altered relaxation.
- This dysfunction can be exacerbated by conditions like hypertension and coronary heart disease.
- Diastolic heart failure, resulting from impaired LV filling, can be misdiagnosed as systolic dysfunction.
Purpose of the Study:
- To determine the incidence of diastolic heart failure in elderly inpatients.
- To highlight the importance of recognizing diastolic dysfunction in geriatric cardiology.
Main Methods:
- Retrospective analysis of echocardiography results from 253 geriatric inpatients over one year.
- Patients were assessed for heart failure symptoms, LV size, systolic function, and diastolic dysfunction.
Main Results:
- Heart failure symptoms were present in 164 patients; 71% had normal LV size.
- Of those with normal LV size and heart failure symptoms, 38% had normal systolic function.
- A significant portion of patients with normal systolic function exhibited diastolic dysfunction, suggesting it as the primary cause of heart failure.
Conclusions:
- Diastolic left ventricular dysfunction is highly prevalent in elderly inpatients with heart failure.
- The findings underscore the critical need to consider and diagnose diastolic heart failure in the geriatric population to ensure correct management.
Abstract:
Age-related changes of diastolic left ventricular (LV) function consist of increased diastolic wall stiffness (reduced compliance) and diminished velocity and extent of relaxation. There is a shift of ventricular filling from early to late diastole. Atrial contribution to LV filling increases, which helps maintain stroke volume. In normal cardiovascular aging this diastolic dysfunction is compensated. However, the aging heart is sensitized against influences aggravating diastolic dysfunction such as arterial hypertension, LV hypertrophy, myocardial ischemia (coronary heart disease), tachycardias/ tachyarrhythmias. In diastolic heart failure LV is unable to fill adequately at normal diastolic pressures, resulting in symptoms of pulmonary congestion and, less often, low output despite normal LV size and contraction. Diastolic heart failure may be misinterpreted as systolic dysfunction and, eventually, treated in an unsuitable manner. In order to obtain data on the incidence of diastolic heart failure among inpatients of a department of geriatrics of a municipal hospital, the results of 253 patients undergoing echocardiography in the course of 1 year were analyzed. The investigations comprised 70 males and 183 females, aged 81.3 (61-98) years on average. In 164 cases, symptoms of heart failure were present. Only in 48 of them (29%) LV proved to be dilated. In the majority, LV size was normal (116 patients; 71%): systolic function was compromised in 53 cases, whereas 63 patients (38% of all cases with heart failure) had a normal systolic function. Most of the latter (48 patients) had diastolic dysfunction, whereas an adequate echocardiographic evaluation was not possible for technical reasons in the remaining 15 cases. It is highly probable, however, that they had diastolic LV dysfunction as well. Thus, the results show a high frequency of LV dysfunction in elderly inpatients, which underlines the importance of diastolic heart failure in this age group.