Diastolic Heart Failure: Recent Concepts
Keywords:
Diastolic dysfunction, Diastolic heart failure, Heart failure with preserved ejection fraction
Abstract
Diastolic dysfunction (DD) of left ventricle as a cause of heart failure in presence of normal or near normal systolic function expressed as ejection fraction (EF) is a relatively recent concept. Understanding the physiology of diastolic function and development of echocardiographic technology and identification of highly sensitive biomarkers has made non-invasive recognition of diastolic heart failure in individual patients easier. It is now estimated that half of the patients having symptoms of heart failure have normal or near normal systolic function in whom diastolic dysfunction remains the cause of heart failure. Ageing, hypertension, ischaemic heart disease, diabetes, obesity and obstructive sleep apnoea are the leading causes of DD. Pharmacological treatment of diastolic heart failure is not well established. Treatment of comorbid conditions remains the mainstay of treatment. It has similar morbidity and mortality compared to heart failure with reduced EF.
References
1. Gaasch W H, Zile M R. Left ventricular diastolic dysfunction and diastolic heart failure. Annu Rev Med. 2004;55:373–394.
2. Brutsaert D L, Sys S U. Relaxation and diastole of the heart. Physiol Rev. 1989;69(4):1228-315.
3. Zile MR, Gaasch WH, Carroll JD et al. Heart failure with a normal ejection fraction: is measurement of diastolic function necessary to make the diagnosis of diastolic heart failure? Circulation. 2001;104:779–782.
4. Apstein CS, Morgan JP. Cellular mechanisms underlying left ventricular diastolic dysfunction. In: Gaasch WH, LeWinter MM, eds. Left Ventricular Diastolic Dysfunction and Heart Failure. Philadelphia, Pa: Lea & Febiger; 1994:3–24.
5. Brutsaert DL, Sys SU. Diastolic dysfunction in heart failure. J Card Fail. 1997;3:225–242. 6. Borbely A, van der Velden J, Papp Z et al. Cardiomyocyte stiffness in diastolic heart failure. Circulation. 2005;111(6):774– 781.
7. Kass D A, Bronzwaer J G, Paulus W J. What mechanisms underlie diastolic dysfunction in heart failure? Circ Res. 2004; 94:1533–1542.
8. Aurigemma GP, Gottdiener JS, Shemanski L, et al. Predictive value of systolic and diastolic function for incident congestive heart failure in the elderly: the Cardiovascular Health Study. J Am Coll Cardiol. 2001;37: 1042–1048.
9. Grossman W. Defining diastolic dysfunction. Circulation. 2000;101: 2020-1.
10. Kitzman DW, Gardin JM, Gottdiener JS et al. for the CHS Research Group. Importance of heart failure with preserved systolic function in patients 65 years of age. Am J Cardiol. 2001;87:413–419.
11. Gandhi S K, Powers J C, Nomeir A M et al. The pathogenesis of acute pulmonary edema associated with hypertension. N Engl J Med. 2001;344(1):17–22.
12. Owan T E, Redfield M M. Epidemiology of diastolic heart failure. Prog Cardiovasc Dis. 2005;47:320–332.
13. Philbin EF, Hunsberger S, Garg R, Lader E, Thadani U, McSherry F et al. and the Digitalis Investigation Group. Usefulness of clinical information to distinguish patients with normal from those with low ejection fractions in heart failure. Am J Cardiol. 2002;89:1218-21.
14. Vasan RS, Levy D. Defining diastolic heart failure: a call for standardized diagnostic criteria. Circulation. 2000;101:2118- 21
15. Appleton CP, Firsterbreg MS, Garcia MJ, et al. The echo-Doppler evaluation of left ventricular diastolic function: a current perspective. Cardiol Clin. 2000;18:513–546.
16. Nagueh SF, Zoghbi WA. Clinical assessment of LV diastolic filling by Doppler echocardiography. ACC Curr J Rev. 2001;Jul/Aug:45–49.
17. Angeja B G, Grossman W. Evaluation and management of diastolic heart failure. Circulation. 2003;107:659–663.
18. Tabata,T, *Thomas JD, Klein AL.Pulmonary venous flow by doppler echocardiography: revisited 12 years later. JACC. 2003;41(8):1243–1250
19. Ommen SR, Nishimura RA, Appleton CP, et al. Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: a comparative simultaneous Doppler-catheterization study. Circulation. 2000;102:1788–1794.
20. JH, Marwick TH. Use and Limitations of E/e’ to Assess Left Ventricular Filling Pressure by Echocardiography. J Cardiovasc Ultrasound. 2011; 19(4):169–173.
21. D’Ander A, Riegler L, Rucco MA et al. Left atrial volume index in healthy subjects: clinical and echocardiographic correlates. Echocardiography. 2013;30(9):1001-7.
22. Garcia MJ, Smedira NG, Greenberg NL et al. Color M-mode Doppler flow propagation velocity is a preload insensitive index of left ventricular relaxation: animal and human validation. J Am Coll Cardiol. 2000;35: 201–208.
23. Quinones M A. Assessment of diastolic function. Prog Cardiovasc Dis. 2005;47:340–355.
24. Maisel AS, McCord J, Nowak RM, Hollander JE, Wu AH, Duc P, et al. Bedside B-type natriuretic peptide in the emergency diagnosis of heart failure with reduced or preserved ejection fraction. Results from the Breathing Not Properly
Multinational Study. J Am Coll Cardiol. 2003;41:2010-7.
25. Zile MR, Simsic JM. Diastolic heart failure: diagnosis and treatment. Clin Cornerstone. 2000;3:13–24.
26. Ahmed A, Rich MW, Fleg JL, Zile MR, Young JB et al. Effects of digoxin on morbidity and mortality in diastolic heart failure: the ancillary digitalis investigation group trial. Circulation. 2006; 114: 397–403
27. Yusuf S, Pfeffer M A, Swedberg K et al. for the CHARM Investigators and Committees. Effects of candesartan in patients with chronic heart failure and preserved left‐ventricular ejection fraction: the CHARM‐Preserved trial. Lancet. 2003;362:777–781.
28. Massie BM, Carson PE, McMurray JJ, Komajda M, McKelvie R, Zile MR et al. Irbesartan in patients with heartfailure and preserved ejection fraction. N Engl J Med 2008;359:2456–2467.
29. Solomon SD, Zile M, Pieske B et al. Prospective comparison of ARNI with ARB on Management Of heart failUre with preserved ejectioN fracTion (PARAMOUNT) Investigators. The angiotensin receptor neprilysin inhibitor Icz696 in heart failure with preserved ejection fraction: a phase 2 double-blind randomised controlled trial. Lancet. 2012;380:1387–1395.
30. Senni M, Redfield MM. Heart failure with preserved systolic function. A different natural history? J Am Coll Cardiol. 2001;38:1277-82.
31. Tribouilloy C, Rusinaru D, Mahjoub H, Soulie`re V et al. Prognosis of heart failure with preserved ejection fraction: a 5 year prospective population-based study. Eur Heart Journal. 2008; 29: 339–347
32. O’Conner CM, Gattis WA, Shaw L et al. Clinical characteristics and long-term outcomes of patients with heart failure and preserved systolic function. Am J Cardiol. 2000;86:863– 867.
33. Dunlay SM, Roger VL, Weston SA et al. Longitudinal changes in Ejection Fraction in Heart failure Patients with preserved and reduced Ejection fraction. Circ heart fail. 2012; 5:720.
34. Vasan RS, Levy D. Defining diastolic heart failure: a call for standardized diagnostic criteria. Circulation. 2000;101:2118– 2121.
2. Brutsaert D L, Sys S U. Relaxation and diastole of the heart. Physiol Rev. 1989;69(4):1228-315.
3. Zile MR, Gaasch WH, Carroll JD et al. Heart failure with a normal ejection fraction: is measurement of diastolic function necessary to make the diagnosis of diastolic heart failure? Circulation. 2001;104:779–782.
4. Apstein CS, Morgan JP. Cellular mechanisms underlying left ventricular diastolic dysfunction. In: Gaasch WH, LeWinter MM, eds. Left Ventricular Diastolic Dysfunction and Heart Failure. Philadelphia, Pa: Lea & Febiger; 1994:3–24.
5. Brutsaert DL, Sys SU. Diastolic dysfunction in heart failure. J Card Fail. 1997;3:225–242. 6. Borbely A, van der Velden J, Papp Z et al. Cardiomyocyte stiffness in diastolic heart failure. Circulation. 2005;111(6):774– 781.
7. Kass D A, Bronzwaer J G, Paulus W J. What mechanisms underlie diastolic dysfunction in heart failure? Circ Res. 2004; 94:1533–1542.
8. Aurigemma GP, Gottdiener JS, Shemanski L, et al. Predictive value of systolic and diastolic function for incident congestive heart failure in the elderly: the Cardiovascular Health Study. J Am Coll Cardiol. 2001;37: 1042–1048.
9. Grossman W. Defining diastolic dysfunction. Circulation. 2000;101: 2020-1.
10. Kitzman DW, Gardin JM, Gottdiener JS et al. for the CHS Research Group. Importance of heart failure with preserved systolic function in patients 65 years of age. Am J Cardiol. 2001;87:413–419.
11. Gandhi S K, Powers J C, Nomeir A M et al. The pathogenesis of acute pulmonary edema associated with hypertension. N Engl J Med. 2001;344(1):17–22.
12. Owan T E, Redfield M M. Epidemiology of diastolic heart failure. Prog Cardiovasc Dis. 2005;47:320–332.
13. Philbin EF, Hunsberger S, Garg R, Lader E, Thadani U, McSherry F et al. and the Digitalis Investigation Group. Usefulness of clinical information to distinguish patients with normal from those with low ejection fractions in heart failure. Am J Cardiol. 2002;89:1218-21.
14. Vasan RS, Levy D. Defining diastolic heart failure: a call for standardized diagnostic criteria. Circulation. 2000;101:2118- 21
15. Appleton CP, Firsterbreg MS, Garcia MJ, et al. The echo-Doppler evaluation of left ventricular diastolic function: a current perspective. Cardiol Clin. 2000;18:513–546.
16. Nagueh SF, Zoghbi WA. Clinical assessment of LV diastolic filling by Doppler echocardiography. ACC Curr J Rev. 2001;Jul/Aug:45–49.
17. Angeja B G, Grossman W. Evaluation and management of diastolic heart failure. Circulation. 2003;107:659–663.
18. Tabata,T, *Thomas JD, Klein AL.Pulmonary venous flow by doppler echocardiography: revisited 12 years later. JACC. 2003;41(8):1243–1250
19. Ommen SR, Nishimura RA, Appleton CP, et al. Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: a comparative simultaneous Doppler-catheterization study. Circulation. 2000;102:1788–1794.
20. JH, Marwick TH. Use and Limitations of E/e’ to Assess Left Ventricular Filling Pressure by Echocardiography. J Cardiovasc Ultrasound. 2011; 19(4):169–173.
21. D’Ander A, Riegler L, Rucco MA et al. Left atrial volume index in healthy subjects: clinical and echocardiographic correlates. Echocardiography. 2013;30(9):1001-7.
22. Garcia MJ, Smedira NG, Greenberg NL et al. Color M-mode Doppler flow propagation velocity is a preload insensitive index of left ventricular relaxation: animal and human validation. J Am Coll Cardiol. 2000;35: 201–208.
23. Quinones M A. Assessment of diastolic function. Prog Cardiovasc Dis. 2005;47:340–355.
24. Maisel AS, McCord J, Nowak RM, Hollander JE, Wu AH, Duc P, et al. Bedside B-type natriuretic peptide in the emergency diagnosis of heart failure with reduced or preserved ejection fraction. Results from the Breathing Not Properly
Multinational Study. J Am Coll Cardiol. 2003;41:2010-7.
25. Zile MR, Simsic JM. Diastolic heart failure: diagnosis and treatment. Clin Cornerstone. 2000;3:13–24.
26. Ahmed A, Rich MW, Fleg JL, Zile MR, Young JB et al. Effects of digoxin on morbidity and mortality in diastolic heart failure: the ancillary digitalis investigation group trial. Circulation. 2006; 114: 397–403
27. Yusuf S, Pfeffer M A, Swedberg K et al. for the CHARM Investigators and Committees. Effects of candesartan in patients with chronic heart failure and preserved left‐ventricular ejection fraction: the CHARM‐Preserved trial. Lancet. 2003;362:777–781.
28. Massie BM, Carson PE, McMurray JJ, Komajda M, McKelvie R, Zile MR et al. Irbesartan in patients with heartfailure and preserved ejection fraction. N Engl J Med 2008;359:2456–2467.
29. Solomon SD, Zile M, Pieske B et al. Prospective comparison of ARNI with ARB on Management Of heart failUre with preserved ejectioN fracTion (PARAMOUNT) Investigators. The angiotensin receptor neprilysin inhibitor Icz696 in heart failure with preserved ejection fraction: a phase 2 double-blind randomised controlled trial. Lancet. 2012;380:1387–1395.
30. Senni M, Redfield MM. Heart failure with preserved systolic function. A different natural history? J Am Coll Cardiol. 2001;38:1277-82.
31. Tribouilloy C, Rusinaru D, Mahjoub H, Soulie`re V et al. Prognosis of heart failure with preserved ejection fraction: a 5 year prospective population-based study. Eur Heart Journal. 2008; 29: 339–347
32. O’Conner CM, Gattis WA, Shaw L et al. Clinical characteristics and long-term outcomes of patients with heart failure and preserved systolic function. Am J Cardiol. 2000;86:863– 867.
33. Dunlay SM, Roger VL, Weston SA et al. Longitudinal changes in Ejection Fraction in Heart failure Patients with preserved and reduced Ejection fraction. Circ heart fail. 2012; 5:720.
34. Vasan RS, Levy D. Defining diastolic heart failure: a call for standardized diagnostic criteria. Circulation. 2000;101:2118– 2121.
Published
2019-07-31
How to Cite
Mishra B. (2019). Diastolic Heart Failure: Recent Concepts. The Indian Practitioner, 69(1), 44-50. Retrieved from https://articles.theindianpractitioner.com/index.php/tip/article/view/505
Section
Review article
