Diastolic heart failure: Difference between revisions
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In [[medicine]] and [[physiology]], '''diastolic heart failure''' or '''diastolic dysfunction''' is "[[heart failure]] caused by abnormal myocardial relaxation during diastolic leading to defective cardiac filling."<ref>{{MeSH}}</ref> | {{TOC|right}} | ||
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."<ref>{{MeSH}}</ref> | |||
Up to 40% of patients with heart failure may not have evidence of systolic dysfunction.<ref name="pmid1503353">{{cite journal| author=Bonow RO, Udelson JE| title=Left ventricular diastolic dysfunction as a cause of congestive heart failure. Mechanisms and management. | journal=Ann Intern Med | year= 1992 | volume= 117 | issue= 6 | pages= 502-10 | pmid=1503353 | A working definition is heart failure without systolic dysfunction.<ref name="pmid1503353">{{cite journal| author=Bonow RO, Udelson JE| title=Left ventricular diastolic dysfunction as a cause of congestive heart failure. Mechanisms and management. | journal=Ann Intern Med | year= 1992 | volume= 117 | issue= 6 | pages= 502-10 | pmid=1503353 | ||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=1503353 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref> Up to 40% of patients with heart failure may not have evidence of systolic dysfunction.<ref name="pmid1503353">{{cite journal| author=Bonow RO, Udelson JE| title=Left ventricular diastolic dysfunction as a cause of congestive heart failure. Mechanisms and management. | journal=Ann Intern Med | year= 1992 | volume= 117 | issue= 6 | pages= 502-10 | pmid=1503353 | |||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=1503353 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref> | | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=1503353 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref> | ||
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]].<ref name="pmid17584565">{{cite journal| author=Osranek M, Seward JB, Buschenreithner B, Bergler-Klein J, Heger M, Klaar U et al.| title=Diastolic function assessment in clinical practice: the value of 2-dimensional echocardiography. | journal=Am Heart J | year= 2007 | volume= 154 | issue= 1 | pages= 130-6 | pmid=17584565 | |||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=17584565 | doi=10.1016/j.ahj.2007.03.026 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref> | |||
==Diagnosis== | ==Diagnosis== | ||
{| class="wikitable" | {| class="wikitable" align="right" | ||
|+ Echocardiography for detecting diastolic heart failure among patients with left ventricular preatrial contraction pressure and normal ejection fraction<ref name="pmid20152696">{{cite journal| author=Dokainish H, Nguyen JS, Sengupta R, Pillai M, Alam M, Bobek J et al.| title=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. | journal=J Am Soc Echocardiogr | year= 2010 | volume= 23 | issue= 2 | pages= 156-61 | pmid=20152696 | |+ Echocardiography for detecting diastolic heart failure among patients with left ventricular preatrial contraction pressure and normal ejection fraction<ref name="pmid20152696">{{cite journal| author=Dokainish H, Nguyen JS, Sengupta R, Pillai M, Alam M, Bobek J et al.| title=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. | journal=J Am Soc Echocardiogr | year= 2010 | volume= 23 | issue= 2 | pages= 156-61 | pmid=20152696 | ||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=20152696 | doi=10.1016/j.echo.2009.11.015 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref> | | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=20152696 | doi=10.1016/j.echo.2009.11.015 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref> | ||
! Finding!! [[Sensitivity and specificity|Sensitivity]]!! [[Sensitivity and specificity|Specificity]] | ! Finding!! [[Sensitivity and specificity|Sensitivity]]!! [[Sensitivity and specificity|Specificity]] | ||
|- | |- | ||
| Mitral annular velocity (E/e') > 13 mm Hg|| 70%|| 93% | | Mitral annular velocity (E/e') > 13 mm Hg||align="center"| 70%||align="center"| 93% | ||
|- | |- | ||
| Left atrial volume index (LAVi) > 31 mL/m2|| 78%|| 76% | | Left atrial volume index (LAVi) > 31 mL/m2||align="center"| 78%||align="center"| 76% | ||
|- | |- | ||
| Pulmonary artery systolic pressure (PAP)||80%|| 64% | | Pulmonary artery systolic pressure (PAP)||align="center"|80%||align="center"| 64% | ||
|- | |- | ||
| E/e' or LAVi<sup>*</sup> ||87%|| 88% | | E/e' or LAVi<sup>*</sup> ||align="center"|87%||align="center"|88% | ||
|- | |- | ||
| colspan="3"|Notes:<br/>* E/e' > 13 mm Hg or LAVi > 31 mL/m2 with E/e' > 7 mm Hg | | colspan="3"|Notes:<br/>* E/e' > 13 mm Hg or LAVi > 31 mL/m2 with E/e' > 7 mm Hg | ||
| Line 27: | Line 32: | ||
The the ratio of peak early (E) or passive diastolic filling and peak atria1 (A) velocities (E/A ratio) of <u><</u> 0.6 is less sensitive.<ref name="pmid2705380">{{cite journal| author=Aguirre FV, Pearson AC, Lewen MK, McCluskey M, Labovitz AJ| title=Usefulness of Doppler echocardiography in the diagnosis of congestive heart failure. | journal=Am J Cardiol | year= 1989 | volume= 63 | issue= 15 | pages= 1098-102 | pmid=2705380 | The the ratio of peak early (E) or passive diastolic filling and peak atria1 (A) velocities (E/A ratio) of <u><</u> 0.6 is less sensitive.<ref name="pmid2705380">{{cite journal| author=Aguirre FV, Pearson AC, Lewen MK, McCluskey M, Labovitz AJ| title=Usefulness of Doppler echocardiography in the diagnosis of congestive heart failure. | journal=Am J Cardiol | year= 1989 | volume= 63 | issue= 15 | pages= 1098-102 | pmid=2705380 | ||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=2705380 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref> | | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=2705380 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref> | ||
Echocardiography may grade the severity of diastolic dysfunction, parameters include:<ref name="pmid19187853">{{cite journal| author=Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA et al.| title=Recommendations for the evaluation of left ventricular diastolic function by echocardiography. | journal=J Am Soc Echocardiogr | year= 2009 | volume= 22 | issue= 2 | pages= 107-33 | pmid=19187853 | |||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=19187853 | doi=10.1016/j.echo.2008.11.023 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref> | |||
* 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== | ==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.<ref name="pmid9036306">{{cite journal| author=| title=The effect of digoxin on mortality and morbidity in patients with heart failure. The Digitalis Investigation Group. | journal=N Engl J Med | year= 1997 | volume= 336 | issue= 8 | pages= 525-33 | pmid=9036306 | 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.<ref name="pmid9036306">{{cite journal| author=| title=The effect of digoxin on mortality and morbidity in patients with heart failure. The Digitalis Investigation Group. | journal=N Engl J Med | year= 1997 | volume= 336 | issue= 8 | pages= 525-33 | pmid=9036306 | ||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=9036306 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref> | | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=9036306 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref> | ||
==Prognosis== | |||
Diastolic dysfunction, even in the absence of clinical [[heart failure]], increases mortality.<ref name="pmid12517230">{{cite journal| author=Redfield MM, Jacobsen SJ, Burnett JC, Mahoney DW, Bailey KR, Rodeheffer RJ| title=Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic. | journal=JAMA | year= 2003 | volume= 289 | issue= 2 | pages= 194-202 | pmid=12517230 | |||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=12517230 }} [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=12954043 Review in: ACP J Club. 2003 Sep-Oct;139(2):51] <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref> E/e' (early mitral annular velocity) may be best predictor.<ref name="pmid24268036">{{cite journal| author=Thavendiranathan P, Yingchoncharoen T, Grant A, Seicean S, Landers SH, Gorodeski EZ et al.| title=Prediction of 30-Day Heart Failure-Specific Readmission Risk by Echocardiographic Parameters. | journal=Am J Cardiol | year= 2013 | volume= | issue= | pages= | pmid=24268036 | doi=10.1016/j.amjcard.2013.09.025 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24268036 }} </ref> | |||
==References== | ==References== | ||
<references/> | <references/> | ||
Latest revision as of 16:15, 18 December 2013
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.