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Primary diastolic heart failure.

Abstract

Diastolic heart failure is defined clinically when signs and symptoms of heart failure are present in the presence of preserved left ventricular systolic function (ejection fraction >45%). The incidence and prevalence of primary diastolic heart failure increases with age and it may be as high as 50% in the elderly. Age, female gender, hypertension, coronary artery disease, diabetes, and increased body mass index are risk factors for diastolic heart failure. Hemodynamic consequences such as increased pulmonary venous pressure, post-capillary pulmonary hypertension, and secondary right heart failure as well as decreased cardiac output are similar to those of systolic left ventricular failure, although the nature of primary left ventricular dysfunction is different. Diagnosis of primary diastolic heart failure depends on the presence of preserved left ventricular ejection fraction. Assessment of diastolic dysfunction is preferable but not mandatory. It is to be noted that increased levels of B-type natriuretic peptide does not distinguish between diastolic and systolic heart failure. Echocardiographic studies are recommended to exclude hypertrophic cardiomyopathy, infiltrative heart disease, primary valvular heart disease, and constrictive pericarditis. Myocardial stress imaging is frequently required to exclude ischemic heart disease. The prognosis of diastolic heart failure is variable; it is related to age, severity of heart failure, and associated comorbid diseases such as coronary artery disease. The prognosis of severe diastolic heart failure is similar to that of systolic heart failure. However, cautious use of diuretics and/or nitrates may cause hypotension and low output state. Heart rate control is essential to improving ventricular filling. Pharmacologic agents such as angiotensin receptor blockers, angiotensin-converting enzyme inhibitors, and calcium channel blockers are used in selected patients to decrease left ventricular hypertrophy. To decrease myocardial fibrosis, aldosterone antagonists have a potential therapeutic role. However, prospective controlled studies will be required to establish their efficacy in primary diastolic heart failure.

Links

  • Publisher Full Text
  • Authors+Show Affiliations

    Chatterjee Center for Cardiac Research, University of California, San Francisco, CA 94143, USA. chatterj@medicine.ucsf.edu

    Source

    MeSH

    Aged
    Diabetes Complications
    Diastole
    Female
    Heart Failure
    Heart Rate
    Humans
    Male
    Obesity
    Prognosis
    Stroke Volume
    Ventricular Dysfunction, Left

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    11986532

    Citation

    Chatterjee, Kanu. "Primary Diastolic Heart Failure." The American Journal of Geriatric Cardiology, vol. 11, no. 3, 2002, pp. 178-87; quiz 188-9.
    Chatterjee K. Primary diastolic heart failure. Am J Geriatr Cardiol. 2002;11(3):178-87; quiz 188-9.
    Chatterjee, K. (2002). Primary diastolic heart failure. The American Journal of Geriatric Cardiology, 11(3), pp. 178-87; quiz 188-9.
    Chatterjee K. Primary Diastolic Heart Failure. Am J Geriatr Cardiol. 2002;11(3):178-87; quiz 188-9. PubMed PMID: 11986532.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Primary diastolic heart failure. A1 - Chatterjee,Kanu, PY - 2002/5/3/pubmed PY - 2002/6/12/medline PY - 2002/5/3/entrez SP - 178-87; quiz 188-9 JF - The American journal of geriatric cardiology JO - Am J Geriatr Cardiol VL - 11 IS - 3 N2 - Diastolic heart failure is defined clinically when signs and symptoms of heart failure are present in the presence of preserved left ventricular systolic function (ejection fraction >45%). The incidence and prevalence of primary diastolic heart failure increases with age and it may be as high as 50% in the elderly. Age, female gender, hypertension, coronary artery disease, diabetes, and increased body mass index are risk factors for diastolic heart failure. Hemodynamic consequences such as increased pulmonary venous pressure, post-capillary pulmonary hypertension, and secondary right heart failure as well as decreased cardiac output are similar to those of systolic left ventricular failure, although the nature of primary left ventricular dysfunction is different. Diagnosis of primary diastolic heart failure depends on the presence of preserved left ventricular ejection fraction. Assessment of diastolic dysfunction is preferable but not mandatory. It is to be noted that increased levels of B-type natriuretic peptide does not distinguish between diastolic and systolic heart failure. Echocardiographic studies are recommended to exclude hypertrophic cardiomyopathy, infiltrative heart disease, primary valvular heart disease, and constrictive pericarditis. Myocardial stress imaging is frequently required to exclude ischemic heart disease. The prognosis of diastolic heart failure is variable; it is related to age, severity of heart failure, and associated comorbid diseases such as coronary artery disease. The prognosis of severe diastolic heart failure is similar to that of systolic heart failure. However, cautious use of diuretics and/or nitrates may cause hypotension and low output state. Heart rate control is essential to improving ventricular filling. Pharmacologic agents such as angiotensin receptor blockers, angiotensin-converting enzyme inhibitors, and calcium channel blockers are used in selected patients to decrease left ventricular hypertrophy. To decrease myocardial fibrosis, aldosterone antagonists have a potential therapeutic role. However, prospective controlled studies will be required to establish their efficacy in primary diastolic heart failure. SN - 1076-7460 UR - https://www.unboundmedicine.com/medline/citation/11986532/Primary_diastolic_heart_failure_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=1076-7460&date=2002&volume=11&issue=3&spage=178 DB - PRIME DP - Unbound Medicine ER -