Diastolic Heart Failure: A Review and Primary Care Perspective

Abstract

Previously the subject of much debate, there is now consensus that diastolic heart failure (DHF) represents a distinct form of heart failure. Epidemiologic data indicate that DHF is common. Indeed, there is evidence that, among elderly persons, DHF is more common than systolic heart failure (SHF). Like SHF, DHF is associated with significant morbidity, mortality, and cost; however, few clinical trials focusing on isolated DHF have been completed. Much of the treatment of DHF is based on current concepts of the pathophysiology of DHF, small clinical studies, and experience gained from treating patients with SHF. The diagnosis of DHF is clinical; data supporting the establishment of a diagnosis of DHF are limited. Differences exist in prognosis and treatment between diastolic and systolic heart failure. This article reviews diastolic heart failure with emphasis on evidence-based management, aimed at primary care physicians who routinely provide care to patients with DHF. (J Am Board Fam Pract 2005;18:189 -98.)

Heart failure in the elderly

“…In 50% of the patients, particularly those at 70 years old or more, the HF is caused by alterations in the diastolic function. When HF is caused by isolated diastolic dysfunction, congestive symptoms result from pulmonary venous hypertension, with normal systolic function and without the occurrence of increased cardiac area [12]. The mortality rate in these cases is comparable to that of systolic HF, with approximately 50% survival rate at five years.…”

Erectile dysfunction in healthy subjects predicts reduced coronary flow velocity reserve

“…Categorization of diastolic flow profiles was based on standard clinical procedure, taking atrial size, maximum early/atrial contraction (E/A) transmitral flow velocity E/A ratio, maximum systolic/diastolic (S/D) pulmonary flow velocity ratio, early transmitral flow velocity deceleration time (Edt), tissue Ddoppler early to atrial contraction tissue velocity (Em/Am) ratio) and E/Em ratio into account [15,16].…”

Advances in diastolic heart failure

“…In patients with signs of volume overload, diuretics are needed and appear to reduce symptoms and improve quality of life [36] , however, it is necessary to avoid an acute drop in LV stroke volume. Diuretic dose for DHF is usually much smaller than for SHF, whereas β blockers are titrated much more rapidly to moderate or high doses in DHF patients based on the clinical response [37] . Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers can lead to regression of LV mass and interstitial fibrosis due partially to their favorable effect on LV stiffness [38] .…”