Diastolic heart failure
In medicine and physiology, diastolic heart failure or diastolic dysfunction is "[a subset of] heart failure caused by abnormal myocardial relaxation during diastolic leading to defective cardiac filling."[1]
A working definition is heart failure without systolic dysfunction.[2] Up to 40% of patients with heart failure may not have evidence of systolic dysfunction.[2]
Diastolic dysfunction usually occurs in the setting of structural heart disease such as either a reduced ejection fraction, enlarged left atrium, or left ventricular hypertrophy.[3]
Diagnosis
| Finding | Sensitivity | Specificity |
|---|---|---|
| Mitral annular velocity (E/e') > 13 mm Hg | 70% | 93% |
| Left atrial volume index (LAVi) > 31 mL/m2 | 78% | 76% |
| Pulmonary artery systolic pressure (PAP) | 80% | 64% |
| E/e' or LAVi* | 87% | 88% |
| Notes: * E/e' > 13 mm Hg or LAVi > 31 mL/m2 with E/e' > 7 mm Hg | ||
Echocardiography may detect diastolic heart failure (see table).[4]
The the ratio of peak early (E) or passive diastolic filling and peak atria1 (A) velocities (E/A ratio) of < 0.6 is less sensitive.[5]
Echocardiography may grade the severity of diastolic dysfunction, parameters include:[6]
- Mild:
- E/A ratio <0.8
- E/e′ ratio < 8
- Moderate (grade II; "impaired myocardial relaxation with mild to moderate elevation of LV filling pressures"):
- E/A ratio 0.8 to 1.5 (pseudonormal)
- E/e′ (average) ratio is 9 to 12
- Severe (grade III; "restrictive LV filling occurs"):
- E/A ratio ≥ 2
- E/e′ (average) ratio > 13
Treatment
Digoxin may reduce the combined outcome of death or hospitalization due to worsening heart failure according the results of the ancillary trial of patients with preserved ejection fraction in a larger randomized controlled trial of treating patients with heart failure.[7]
Prognosis
Diastolic dysfunction, even in the absence of clinical heart failure, increases mortality.[8] E/e' (early mitral annular velocity) may be best predictor.[9]
References
- ↑ Anonymous (2024), Diastolic heart failure (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ 2.0 2.1 Bonow RO, Udelson JE (1992). "Left ventricular diastolic dysfunction as a cause of congestive heart failure. Mechanisms and management.". Ann Intern Med 117 (6): 502-10. PMID 1503353.
- ↑ Osranek M, Seward JB, Buschenreithner B, Bergler-Klein J, Heger M, Klaar U et al. (2007). "Diastolic function assessment in clinical practice: the value of 2-dimensional echocardiography.". Am Heart J 154 (1): 130-6. DOI:10.1016/j.ahj.2007.03.026. PMID 17584565. Research Blogging.
- ↑ 4.0 4.1 Dokainish H, Nguyen JS, Sengupta R, Pillai M, Alam M, Bobek J et al. (2010). "Do additional echocardiographic variables increase the accuracy of E/e' for predicting left ventricular filling pressure in normal ejection fraction? An echocardiographic and invasive hemodynamic study.". J Am Soc Echocardiogr 23 (2): 156-61. DOI:10.1016/j.echo.2009.11.015. PMID 20152696. Research Blogging.
- ↑ Aguirre FV, Pearson AC, Lewen MK, McCluskey M, Labovitz AJ (1989). "Usefulness of Doppler echocardiography in the diagnosis of congestive heart failure.". Am J Cardiol 63 (15): 1098-102. PMID 2705380.
- ↑ Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA et al. (2009). "Recommendations for the evaluation of left ventricular diastolic function by echocardiography.". J Am Soc Echocardiogr 22 (2): 107-33. DOI:10.1016/j.echo.2008.11.023. PMID 19187853. Research Blogging.
- ↑ (1997) "The effect of digoxin on mortality and morbidity in patients with heart failure. The Digitalis Investigation Group.". N Engl J Med 336 (8): 525-33. PMID 9036306.
- ↑ Redfield MM, Jacobsen SJ, Burnett JC, Mahoney DW, Bailey KR, Rodeheffer RJ (2003). "Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic.". JAMA 289 (2): 194-202. PMID 12517230. Review in: ACP J Club. 2003 Sep-Oct;139(2):51
- ↑ Thavendiranathan P, Yingchoncharoen T, Grant A, Seicean S, Landers SH, Gorodeski EZ et al. (2013). "Prediction of 30-Day Heart Failure-Specific Readmission Risk by Echocardiographic Parameters.". Am J Cardiol. DOI:10.1016/j.amjcard.2013.09.025. PMID 24268036. Research Blogging.