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Diastolic heart failure in the elderly
Jeffrey H Barsuk,William G Cotts,
Jeffrey H. Barsuk
,William G. Cotts

老年心脏病学杂志(英文版) , 2006,
Abstract: Heart failure with preserved left ventricular function is a common problem among elderly patients.Given that diastolic heart failure(DHF)occurs in up to 50% of all heart failure admissions,and that incidence increases with age,knowledge of current recommendations for its diagnosis and treatment are extremely important for the elderly population.Causes of DHF include the aging process itself,hypertension,left ventricular hypertrophy,aortic stenosis,and hypertrophic obstructive cardiomyopathy.The patient with DHF may present with signs and symptoms similar to those observed in systolic heart failure.Treatment goals for the patient with DHF include achieving normal volume status,improving relaxation of the left ventricle,regression of hypertrophy if possible,and management of any co-morbidities that may aggravate the clinical status of patients with DHF.Hopefully,in the future,further data from randomized clinical trials will allow a more defined approach to care in these patients.
Similarities and Differences between the Pathogenesis and Pathophysiology of Diastolic and Systolic Heart Failure  [PDF]
Kazuo Komamura
Cardiology Research and Practice , 2013, DOI: 10.1155/2013/824135
Abstract: Pathophysiology of heart failure has been considered to be a damaged state of systolic function of the heart followed by a state of low cardiac output that is, systolic heart failure. Even if systolic function is preserved, left ventricular filling in diastole can be impeded and resulted in elevation of filling pressure and symptoms of heart failure. This kind of heart failure is called diastolic heart failure. Nowadays, diastolic heart failure is referred to as heart failure with preserved ejection fraction (HFpEF), whereas systolic heart failure is referred to as heart failure with reduced ejection fraction (HFrEF). In this paper, the similarities and differences between the pathogenesis and pathophysiology of diastolic and systolic heart failure were reviewed. Although diastolic heart failure is a common condition of heart failure worldwide, its pathophysiology has not been sufficiently elucidated. This is thought to be the most significant reason for a lack of established treatment methods for diastolic heart failure. We hope to proceed with future studies on this topic. 1. Introduction Pathophysiology of heart failure has been considered to be a damaged state of systolic function of the heart followed by a state of low cardiac output (systolic heart failure). However, even if systolic function is preserved, left ventricular filling in diastole is impeded due to various factors. This condition leads to congestive heart failure due to the rise in left ventricular end-diastolic pressure and the decrease in cardiac output. This kind of pathophysiology is now known as diastolic heart failure [1, 2]. In recent years, diastolic heart failure caused by the affected left ventricle has become a clinical issue [3]. Nowadays, diastolic heart failure is referred to as heart failure with preserved ejection fraction (HFpEF), whereas systolic heart failure is referred to as heart failure with reduced ejection fraction (HFrEF). This is because evaluating accurate pathophysiology and diagnosis of diastolic heart failure is in fact difficult. 2. Diastolic Dysfunction Diastole of the left ventricle is composed of isovolumic relaxation and ventricular filling. Relaxation of the left ventricle is an active process that occurs as a result of energy-dependent uptake of intracellular calcium by the sarcoplasmic reticulum, whose concentration has risen during the systolic phase. Relaxation of the left ventricle is impaired in a disease state caused by energy metabolism disorders or calcium-handling abnormalities such as myocardial ischemia and myocardial hypertrophy. Left
Comparison of the effect of pressure loading on left ventricular size, systolic and diastolic function in canines with left ventricular dysfunction with preserved and reduced ejection fraction
Steven J Lavine, Donald A Conetta
Cardiovascular Ultrasound , 2008, DOI: 10.1186/1476-7120-6-57
Abstract: We studied 25 dogs with chronic LV dysfunction due to coronary microsphere embolization with RedEF (35 ± 4%) and 20 dogs with PreEF (50 ± 3%). Arterial pressure was increased with methoxamine infusion and hemodynamics and echo-Doppler parameters of LV size, function, transaortic and transmitral pulsed Doppler prior to and with methoxamine infusion was obtained.Though LV filling pressures were similar at baseline, LV size was larger (p < 0.01) and ejection fraction lower in dogs with RedEF (p < 0.001). With methoxamine, there were similar increases in LV size, LV pressures, and index of myocardial performance with the ejection fraction reduced similarly. Diastolic parameters demonstrated similar tau increases, E/A reduction, and diastolic filling shortening in RedEF and PreEF dogs. A similar extent of isovolumic contraction and relaxation times and index of myocardial performance prolongation occurred with pressure loading.Pressure loading in a canine model of LV dysfunction with PreEF and RedEF resulted in similar degrees of LV dilatation, increased filling pressures, and increased index of myocardial performance.Decompensated heart failure is clinically indistinguishable in patients with either preserved or reduced left ventricular (LV) ejection fraction and may be accompanied by elevated arterial pressures. Although systolic dysfunction is often suspected, it is only after noninvasive imaging that the clinician discovers that the ejection fraction may be in the normal range. This may occur in up to 40–50% of patients depending on age and sex and is more common in elderly females with diabetes [1,2]. In addition, in patients with heart failure and LV systolic dysfunction, a significant though lower percentage of patients also have hypertension. Using a chronic canine model of LV dysfunction with either preserved or reduced ejection fraction induced by coronary microsphere embolization, we previously demonstrated that acute arterial pressure elevation results in mar
Prevalence of Left Ventricular Diastolic Asynchrony in Patient with Systolic Heart Failure
M Esmaeilzadeh,H Saadatifar,A Mohebbi,F Noohi
Iranian Cardiovascular Research Journal , 2009,
Abstract: Background: To study the occurrence of left ventricular (LV) diastolic asynchrony in patients with systolic heart failure (HF) and its relationship to diastolic function regardless of QRS duration.Recent work has demonstrated that intraventricular asynchrony is a common finding in patients with systolic heart failure. Little attention has been paid to diastolic asynchrony in patients with systolic heart failure. We have therefore decided to determine the extent to which patients with systolic heart failure have evidence of diastolic asynchrony and whether or not diastolic asynchrony is correlated with diastolic dysfunction. Patients and Methods: Tissue Doppler echocardiography was performed in 50 HF patients (LV EF=23 ± 8%). Diastolic and systolic asynchrony was determined by tissue synchronization imaging using a 6 basal, 6 mid-segmental model. Systolic and diastolic asynchrony were assessed by the maximal difference in time to peak systolic and early diastolic velocities between any two of 12 LV segments, and the standard deviation of time to peak systolic and early diastolic velocities of the 12 LV segments.Results: The mean ± SD maximal difference in time to peak systolic velocity (controls: 17.2± 9.6 ms versus narrow QRS: 66.7 ± 38.0 ms versus wide QRS: 76.5± 34.6 ms, both P<0.05 versus controls) and in standard deviation of time to peak systolic velocity of 12 LV segments (controls: 15± 6.1 ms versus narrow QRS: 25.9± 15.3 ms versus wide QRS: 28.6±14.4ms, both P<0.05 versus controls) was prolonged in both the narrow and wide QRS groups compared with normal controls. Similarly, the maximal difference in time to peak diastolic velocity (controls: 39± 16.8 ms versus narrow QRS: 73.1± 58ms versus wide QRS: 108.5± 168 ms, both P<0.05 versus controls) and in standard deviation of time to peak early diastolic velocity of 12 LV segments (controls: 15.3±5.8ms versus narrow QRS: 25.1± .13.8ms versus wide QRS: 25.5± 14.9ms, both P<0.05 versus controls) was prolonged in both the narrow and wide QRS groups. The respective prevalence of systolic and diastolic asynchrony was 31.4% and 20%, in the narrow QRS group, and 40% and 28.6%, in the wide QRS group respectively.Stepwise multiple regression analysis showed that low ejection fraction and low mitral annular early diastolic velocity were independent predictors of both systolic and diastolic asynchrony. QRS complex duration was found to correlate only with diastolic asynchrony.Conclusions: LV systolic and diastolic mechanical asynchrony is common in patients with HF regardless of QRS duration. Selection for car
Myocardial tissue Doppler echocardiography and N-terminal B-type natriuretic peptide (NT-proBNP) in diastolic and systolic heart failure
Fabian Knebel, Stephan Eddicks, Ingolf Schimke, Michael Bierbaum, Sebastian Schattke, Mark Beling, Vanessa Raab, Gert Baumann, Adrian C Borges
Cardiovascular Ultrasound , 2008, DOI: 10.1186/1476-7120-6-45
Abstract: 137 consecutive clinically stable patients were included (42 healthy controls, 43 with diastolic heart failure, 52 with systolic heart failure). In diastolic heart failure, basal septal strain was reduced (-24.8 ± 8.1% vs. controls. -18.5 ± 5.3%, p < 0.0001). In all patients with preserved systolic function, septal basal longitudinal displacement was impaired in patients with increased left-ventricular filling pressures (E/E' < 8: 13.5 mm ± 3.3 mm vs. E/E' > 15: 8.5 mm ± 2.3 mm, p = 0.001) parallel to NT-proBNP elevation (E/E' < 8: 45.8 pg/ml, IQR: 172.5 pg/ml vs. E/E' > 15: 402.0 pg/ml, IQR: 1337.2 pg/ml; p = 0.0007). In ROC analysis, NT-proBNP could detect patients with reduced left ventricular systolic function (LVEF ≥ 55%) with a good diagnostic accuracy. However, the diagnostic accuracy of NT-proBNP to detect diastolic dysfunction was lower.Subtle changes of longitudinal myocardial function begin in diastolic heart failure and are further increased in systolic heart failure. In patients with preserved LV function, a complex approach with the integration of multiple parameters including Tissue Doppler echocardiography and NT-proBNP is necessary to classify patients.The prevalence of both systolic and diastolic heart failure is high and the prognosis is comparably poor. The prevalence of diastolic heart failure is increasing and the survival rates remain low, whereas the survival rates of systolic heart failure have improved in recent years. Diastolic heart failure is characterized by abnormal myocardial relaxation and increased passive stiffness and is hard to distinguish from systolic heart failure by clinical examination alone [1-8].It was suggested that there is no isolated diastolic dysfunction, but that there is a continuum from normal to impaired diastolic and then systolic dysfunction (concept of "single syndrome"). The impairment of the longitudinal systolic function measured by Tissue Doppler Imaging (TDI) in patients with diastolic dysfunction supports
Left atrioventricular remodeling in the assessment of the left ventricle diastolic function in patients with heart failure: a review of the currently studied echocardiographic variables
Luiz C Danzmann, Luiz Bodanese, Ilmar K?hler, Marco R Torres
Cardiovascular Ultrasound , 2008, DOI: 10.1186/1476-7120-6-56
Abstract: Heart failure is considered a world endemic problem and data ratified by The European Society of Cardiology (ESC), according to recent publications, estimates a prevalence of symptomatic manifestations in the general European population ranging from 0.4 to 2% [1]. In other countries, for over three decades, acute myocardial infarction (AMI) is the most frequent cause of deaths among the adult population – as, for instances, seen in southern Brazilian cities-, and mortality exhibits increase for both sexes as the age increases [2]. Cardiac failure (CF) in fact is a complex syndrome, embracing systemic complications determined by all forms of heart disease, and it is the common end for the most prevalent illnesses, like the atherosclerotic coronary disease and systemic arterial hypertension (SAH). The population percentage growth of elderly people in Brazil is a fact, at it is estimated to be around 30 million over 60 years of age in 2025, or 15% of the expected Brazilian population for the period [3], and this will much contribute for the increase of incidence and prevalence in the rates of heart failure. In this context, the epidemiological importance of the syndrome justifies the significant growing interest in the research area through the organization of CF specific investigation centers in University hospitals, and public policies of investment aiming at primary or secondary prevention of the risky population.Under the physiopathologic point of view, CF is characterized as myocardial function failure. Without neglecting the autonomous nervous system hormonal mechanisms or the other adapting or deleterious bimolecular implications, the most relevant aspect is that, in this case, the cardiac structure does not provide contraction and ejection with sufficient systolic volume, and does not promote the adequate diastolic arrangements or both situations are not processed appropriately. And this heart dysfunction is closely associated with the heart geometric structura
Adaptation to periodic pressure chamber hypoxia and its influence on systolic and diastolic functions in chronic heart failure  [PDF]
Dmitrieva М.К.
Saratov Journal of Medical Scientific Research , 2012,
Abstract: Research objective is to determine the influence of adaptation method to periodic pressure chamber hypoxia on dynamics of systolic and diastolic functions of myocardium in patients with early stages of chronic heart failure. Materials and Methods: 100 men with post-infarction cardiosclerosis at the age of 40-65 years with I and IIA stages and l-ll functional classes (NYHA) of chronic heart failure have been examined. Results: Positive dynamics of systolic and diastolic cardiac functions and other parameters of echocardioscopy under the influence of the hypoxic therapy in comparison with classical physical rehabilitation have been obtained. Furthermore, a more significant effect has been observed in patients with CHF IIA. Conclusion: Improvement in the geometry of the heart has proved that adaptation method to periodic pressure chamber hypoxia could be recommended for rehabilitation of patients with heart failure of early stages.
Evaluation of Patients with Heart Failure, Preserved Systolic Function and Diastolic Dysfunction  [cached]
Florin Petru ANTON
Applied Medical Informatics , 2012,
Abstract: Aim: Assessment of the occurrence, severity and progress of the diastolic dysfunction in patients with clinically manifest heart failure with preserved systolic function, by analyzing the ultrasound parameters that define the diastolic ventricular function, recorded dynamically. Material and Method: The study involved 200 patients suffering from clinically manifest heart failure, admitted in Cardiology Department of Medical no 1, Cluj-Napoca; an echocardiographic study of the systolic and diastolic function was performed, by the same person, for each of them. The echocardiographic study was carried out dynamically, at first within 3 days of the first examination, then, after 9 months. In the present study we selected patients with an ejection fraction> = 50% and diastolic dysfunction. Results: Of the 200 patients initially evaluated, 43 patients were selected based on the inclusion criteria for diastolic dysfunction. The E '/ A' ratios in the lateral regions of the mitral annulus showed a statistically significant improvement when dynamically assessed (0.71 versus 0, 6, p = 0.016). Also, E / E' ratio in the lateral portion of the mitral annulus significantly improved (6.15 vs. 5.44, p = 0.016) and MPI dynamical assessment shows a statistically significant improvement in this parameter (0.52 vs. 0.46 p = 0.014). Conclusions: Diastolic function assessment should be an integral part of the cardiac function assessment due to the increased prevalence of the patients with HF and preserved systolic function. Our study showed that the most reliable parameters used to assess the diastolic dysfunction in patients with preserved systolic function are the following: the E '/ A' ratio at the level of the septum, the E / E' ratio at the level of the lateral wall, as well as the MPI estimate.
Influence of Metoprolol on Systolic and Diastolic Function in Children with Heart Failure  [PDF]
F.R. Ghader,A. Abaskhanian
Pakistan Journal of Biological Sciences , 2009,
Abstract: The aim of this study was to assess the effect of metoprolol on cardiac function in children with heart failure. This randomized double-blind placebo controlled clinical trial was performed in children with heart failure due to left ventricle volume overload structural heart disease such as VSD, PDA, AI and MR who referred to pediatric cardiology clinics in sari in 2007. The patients divided into case and control groups. All cases were matched as viewpoints of age, sex, weight, kinds of primary disease and cardiac drugs (except for metoprolol).Metoprolol with single daily dose of 1 mg kg-1 and placebo were given to patients in case and control groups respectively. Echocardiography with cardiac indices of systolic and diastolic function was done as baseline and monthly for 3 months in all the patients. Data were analyzed using SPSS software and statistical t-test. Thirty patients (16 cases and 14 controls) were enrolled in the study. CI, MPI and dv/dt (dt) decreased significantly at first month. Significant changes in LVEF and EPSS appeared on the second month and in E wave and E/A appeared on the third month. The results were in favor of systolic and diastolic improvement. Metoprolol causes improvement of cardiac systolic and diastolic function in children with heart failure due to cardiac defect. Therefore, metoprolol is recommended in patients with heart failure in above mentioned diseases that have not been controlled adequately in spite of receiving standard cardiac failure drug therapy such as an inotrope, a diuretic and a vasodilator agent.
Congestive heart failure. Correlation between functional class and systolic and diastolic functions assessed by Doppler echocardiography
Kamel, Cesar Selem;Siqueira-Filho, Aristarco G.;Barreto, Luiz Felipe Mena;Benchimol, Marcos;
Arquivos Brasileiros de Cardiologia , 2001, DOI: 10.1590/S0066-782X2001000200004
Abstract: objective: to evaluate the influence of systolic or diastolic dysfunction, or both on congestive heart failure functional class. methods: thirty-six consecutive patients with a clinical diagnosis of congestive heart failure with sinus rhythm, who were seen between september and november of 1998 answered an adapted questionnaire about tolerance to physical activity for the determination of nyha functional class. the patients were studied with transthoracic doppler echocardiography. two groups were compared: group 1 (19 patients in functional classes i and ii) and group 2 (17 patients in functional classes iii and iv). results: the average ejection fraction was significantly higher in group 1 (44.84%±8.04% vs. 32.59%±11.48% with p=0.0007). the mean ratio of the initial/final maximum diastolic filling velocity (e/a) of the left ventricle was significantly smaller in group 1 (1.07±0.72 vs. 1.98±1.49 with p=0.03). the average maximum systolic pulmonary venous velocity (s) was significantly higher in group 1 (53.53cm/s ± 12.02cm/s vs. 43.41cm/s ± 13.55cm/s with p=0.02). the mean ratio of maximum systolic/diastolic pulmonary venous velocity was significantly higher in group 1 (1.52±0.48 vs. 1.08±0.48 with p=0.01). a predominance of pseudo-normal and restrictive diastolic patterns existed in group 2 (58.83% in group 2 vs. 21.06% in group 1 with p=0.03). conclusion: both the systolic dysfunction index and the patterns of diastolic dysfunction evaluated by doppler echocardiography worsened with the evolution of congestive heart failure.
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