Circulation. 2002;105:1387-1393
doi: 10.1161/hc1102.105289
doi: 10.1161/hc1102.105289
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(Circulation. 2002;105:1387.)
© 2002 American Heart Association, Inc.
Clinical Cardiology: New Frontiers |
New Concepts in Diastolic Dysfunction and Diastolic Heart Failure: Part I
Diagnosis, Prognosis, and Measurements of Diastolic Function
From the Division of Cardiology (M.R.Z.), Department of Medicine, Medical University of South Carolina, The Gazes Cardiac Research Institute and the Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, SC; and the Departments of Physiology and Medicine (D.L.B.), University of Antwerp, Antwerp, Belgium.
Reprint requests to Michael R. Zile, MD, Cardiology Division, Medical University of South Carolina, 96 Jonathan Lucas St, Suite 816, Charleston, SC 29425. E-mail zilem@musc.edu
Key Words: heart failure • diastole • systole
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Introduction |
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There is growing recognition that congestive heart failure (CHF) caused by a predominant abnormality in diastolic function (ie, diastolic heart failure) is both common and causes significant morbidity and mortality. However, there is continued controversy surrounding the definition of diastolic dysfunction and the diagnostic criteria for diastolic heart failure. As a result, clinical therapeutic trials have been slow to develop and difficult to design. Fortunately, these controversies are yielding to an emerging consensus. Recent clinical studies have provided sufficient data to develop standardized diagnostic criteria to define diastolic heart failure.1–4 Experimental studies have provided increased insight into the mechanisms that cause diastolic heart failure.5–22 Together, these clinical and experimental studies are being used to design targeted clinical trials to test effective treatments for diastolic heart failure. The purpose of this 2-part article is to provide a perspective on these issues, highlight new research, and introduce emerging ideas. Part 1 will focus on the criteria used to diagnose diastolic heart failure, the effects of diastolic heart failure on prognosis, and measurements used to assess diastolic function. Part 2 will describe the mechanisms that cause diastolic heart failure and discuss approaches to treatment.
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Definitions |
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Differentiating Diastolic Dysfunction From Diastolic Heart Failure
Heart failure is a clinical syndrome characterized by symptoms and signs of increased tissue/organ water and decreased tissue/organ perfusion. Standardized criteria to diagnose heart failure have been developed, perhaps the best validated of which come from the Framingham Study.23 Definition of the mechanisms that cause this clinical syndrome requires measurement of both systolic and diastolic function. When heart failure
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M. Castella, G. D. Buckberg, and S. Saleh Diastolic dysfunction in stunned myocardium: a state of abnormal excitation-contraction coupling that is limited by Na+-H+ exchange inhibition Eur. J. Cardiothorac. Surg., April 1, 2006; 29(Suppl_1): S107 - S114. [Abstract] [Full Text] [PDF]
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K. A. Connelly, D. L. Prior, D. J. Kelly, M. P. Feneley, H. Krum, and R. E. Gilbert Load-sensitive measures may overestimate global systolic function in the presence of left ventricular hypertrophy: a comparison with load-insensitive measures Am J Physiol Heart Circ Physiol, April 1, 2006; 290(4): H1699 - H1705. [Abstract] [Full Text] [PDF]
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J. K. Oh, L. Hatle, A. J. Tajik, and W. C. Little Diastolic Heart Failure Can Be Diagnosed by Comprehensive Two-Dimensional and Doppler Echocardiography J. Am. Coll. Cardiol., February 7, 2006; 47(3): 500 - 506. [Abstract] [Full Text] [PDF]
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Q. Ruan, L. Rao, K. J. Middleton, D. S. Khoury, and S. F. Nagueh Assessment of left ventricular diastolic function by early diastolic mitral annulus peak acceleration rate: experimental studies and clinical application J Appl Physiol, February 1, 2006; 100(2): 679 - 684. [Abstract] [Full Text] [PDF]
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G. P. Aurigemma, M. R. Zile, and W. H. Gaasch Contractile Behavior of the Left Ventricle in Diastolic Heart Failure: With Emphasis on Regional Systolic Function Circulation, January 17, 2006; 113(2): 296 - 304. [Full Text] [PDF]
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M. M. Riordan and S. J. Kovacs Quantitation of mitral annular oscillations and longitudinal "ringing" of the left ventricle: a new window into longitudinal diastolic function J Appl Physiol, January 1, 2006; 100(1): 112 - 119. [Abstract] [Full Text] [PDF]
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T. K. Lim, H. Ashrafian, G. Dwivedi, P. O. Collinson, and R. Senior Increased left atrial volume index is an independent predictor of raised serum natriuretic peptide in patients with suspected heart failure but normal left ventricular ejection fraction: Implication for diagnosis of diastolic heart failure Eur J Heart Fail, January 1, 2006; 8(1): 38 - 45. [Abstract] [Full Text] [PDF]
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M. Guazzi, J. Myers, and R. Arena Cardiopulmonary Exercise Testing in the Clinical and Prognostic Assessment of Diastolic Heart Failure J. Am. Coll. Cardiol., November 15, 2005; 46(10): 1883 - 1890. [Abstract] [Full Text] [PDF]
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C. Tschope, M. Kasner, D. Westermann, R. Gaub, W. C. Poller, and H.-P. Schultheiss The role of NT-proBNP in the diagnostics of isolated diastolic dysfunction: correlation with echocardiographic and invasive measurements Eur. Heart J., November 1, 2005; 26(21): 2277 - 2284. [Abstract] [Full Text] [PDF]
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A. van Straten, H. W. Vliegen, H. J. Lamb, S. D. Roes, E. E. van der Wall, M. G. Hazekamp, and A. de Roos Time Course of Diastolic and Systolic Function Improvement After Pulmonary Valve Replacement in Adult Patients With Tetralogy of Fallot J. Am. Coll. Cardiol., October 18, 2005; 46(8): 1559 - 1564. [Abstract] [Full Text] [PDF]
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Developed in Collaboration With the American Colle, Endorsed by the Heart Rhythm Society, S. A. Hunt, W. T. Abraham, M. H. Chin, A. M. Feldman, G. S. Francis, T. G. Ganiats, M. Jessup, M. A. Konstam, et al. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult--Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure) J. Am. Coll. Cardiol., September 20, 2005; 46(6): 1116 - 1143. [Full Text] [PDF]
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