Circulation. 2002;105:1503-1508
doi: 10.1161/hc1202.105290
doi: 10.1161/hc1202.105290
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(Circulation. 2002;105:1503.)
© 2002 American Heart Association, Inc.
New Concepts in Diastolic Dysfunction and Diastolic Heart Failure: Part II
Causal Mechanisms and Treatment
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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As described in Part I of this 2-part article,1 diastolic heart failure is common and causes significant alterations in prognosis. In Part II, experimental studies that have provided insight into the mechanisms that cause diastolic heart failure will be described.2–19 In addition, current treatment strategies and the design of future clinical trials of diastolic heart failure will be discussed. The development of truly effective therapy for diastolic heart failure depends on gaining a clear understanding of the basic mechanisms that alter diastolic function and the ability to efficiently target these mechanisms to correct these abnormalities in diastolic function.
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Mechanisms That Cause Diastolic Dysfunction |
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Conceptually, the mechanisms that cause abnormalities in diastolic function that lead to the development of diastolic heart failure can be divided into factors intrinsic to the myocardium itself (myocardial) and factors that are extrinsic to the myocardium (extramyocardial; Table 1). Myocardial factors can be divided into structures and processes within the cardiac muscle cell (cardiomyocyte), within the extracellular matrix (ECM) that surrounds the cardiac muscle cell, and that activate the autocrine or paracrine production of neurohormones. Each of these mechanisms are active in the major pathological processes that result in diastolic dysfunction and heart failure. Myocardial and extramyocardial mechanisms, cellular and extracellular mechanisms, and neurohumoral activation each play a role in the development of diastolic heart failure caused by ischemia, pressure-overload hypertrophy, and restrictive and hypertrophic cardiomyopathy.
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Cardiomyocyte
Diastolic dysfunction can be caused by mechanisms that are intrinsic to the cardiac muscle cells themselves. These include changes in
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A. Arbab-Zadeh, E. Dijk, A. Prasad, Q. Fu, P. Torres, R. Zhang, J. D. Thomas, D. Palmer, and B. D. Levine Effect of Aging and Physical Activity on Left Ventricular Compliance Circulation, September 28, 2004; 110(13): 1799 - 1805. [Abstract] [Full Text] [PDF]
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P. S. Villars, S. K. Hamlin, A. D. Shaw, and J. T. Kanusky Role of Diastole in Left Ventricular Function, I: Biochemical and Biomechanical Events Am. J. Crit. Care., September 1, 2004; 13(5): 394 - 403. [Abstract] [Full Text] [PDF]
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R.C. Jones, G. S. Francis, and M. S. Lauer Predictors of mortality in patients with heart failure and preserved systolic function in the Digitalis Investigation Group trial J. Am. Coll. Cardiol., September 1, 2004; 44(5): 1025 - 1029. [Abstract] [Full Text] [PDF]
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P. M. Mottram, B. Haluska, R. Leano, D. Cowley, M. Stowasser, and T. H. Marwick Effect of Aldosterone Antagonism on Myocardial Dysfunction in Hypertensive Patients With Diastolic Heart Failure Circulation, August 3, 2004; 110(5): 558 - 565. [Abstract] [Full Text] [PDF]
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S. F. Nagueh, G. Shah, Y. Wu, G. Torre-Amione, N. M.P. King, S. Lahmers, C. C. Witt, K. Becker, S. Labeit, and H. L. Granzier Altered Titin Expression, Myocardial Stiffness, and Left Ventricular Function in Patients With Dilated Cardiomyopathy Circulation, July 13, 2004; 110(2): 155 - 162. [Abstract] [Full Text] [PDF]
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I N Alecrin, J M Aldrighi, M A Caldas, O C E Gebara, N H M Lopes, and J A F Ramires Acute and chronic effects of oestradiol on left ventricular diastolic function in hypertensive postmenopausal women with left ventricular diastolic dysfunction Heart, July 1, 2004; 90(7): 777 - 781. [Abstract] [Full Text] [PDF]
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P. Banerjee, A. L. Clark, N. Nikitin, and J. G.F. Cleland Diastolic heart failure. Paroxysmal or chronic? Eur J Heart Fail, June 1, 2004; 6(4): 427 - 431. [Abstract] [Full Text] [PDF]
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M C Petrie, K Hogg, L Caruana, and J J V McMurray Poor concordance of commonly used echocardiographic measures of left ventricular diastolic function in patients with suspected heart failure but preserved systolic function: is there a reliable echocardiographic measure of diastolic dysfunction? Heart, May 1, 2004; 90(5): 511 - 517. [Abstract] [Full Text] [PDF]
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J. Yoshida, K. Yamamoto, T. Mano, Y. Sakata, N. Nishikawa, M. Nishio, T. Ohtani, T. Miwa, M. Hori, and T. Masuyama AT1 Receptor Blocker Added to ACE Inhibitor Provides Benefits at Advanced Stage of Hypertensive Diastolic Heart Failure Hypertension, March 1, 2004; 43(3): 686 - 691. [Abstract] [Full Text] [PDF]
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K. Hogg, K. Swedberg, and J. McMurray Heart failure with preserved left ventricular systolic function: epidemiology, clinical characteristics, and prognosis J. Am. Coll. Cardiol., February 4, 2004; 43(3): 317 - 327. [Abstract] [Full Text] [PDF]
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S. Nodari, M. Metra, and L. D. Cas {beta}-Blocker treatment of patients with diastolic heart failure and arterial hypertension. A prospective, randomized, comparison of the long-term effects of atenolol vs. nebivolol Eur J Heart Fail, October 1, 2003; 5(5): 621 - 627. [Abstract] [Full Text] [PDF]
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 S. A. F. Tulner, R. J. M. Klautz, G. L. van Rijk-Zwikker, F. H. M. Engbers, J. J. Bax, J. Baan, E. E. van der Wall, R. A. Dion, and P. Steendijk Perioperative Assessment of Left Ventricular Function by Pressure-Volume Loops Using the Conductance Catheter Method Anesth. Analg., October 1, 2003; 97(4): 950 - 957. [Abstract] [Full Text] [PDF]
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P. Andrew Diastolic Heart Failure Demystified Chest, August 1, 2003; 124(2): 744 - 753. [Abstract] [Full Text] [PDF]
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M. Jessup and S. Brozena Heart Failure N. Engl. J. Med., May 15, 2003; 348(20): 2007 - 2018. [Full Text] [PDF]
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M. R. Zile Heart failure with preserved ejection fraction: is this diastolic heart failure? J. Am. Coll. Cardiol., May 7, 2003; 41(9): 1519 - 1522. [Full Text] [PDF]
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D. Burkhoff, M. S. Maurer, and M. Packer Heart Failure With a Normal Ejection Fraction: Is It Really a Disorder of Diastolic Function? Circulation, February 11, 2003; 107(5): 656 - 658. [Full Text] [PDF]
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B. G. Angeja and W. Grossman Evaluation and Management of Diastolic Heart Failure Circulation, February 11, 2003; 107(5): 659 - 663. [Full Text] [PDF]
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M. Kawaguchi, I. Hay, B. Fetics, and D. A. Kass Combined Ventricular Systolic and Arterial Stiffening in Patients With Heart Failure and Preserved Ejection Fraction: Implications for Systolic and Diastolic Reserve Limitations Circulation, February 11, 2003; 107(5): 714 - 720. [Abstract] [Full Text] [PDF]
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D. G Gibson and D. P Francis CLINICAL ASSESSMENT OF LEFT VENTRICULAR DIASTOLIC FUNCTION Heart, February 1, 2003; 89(2): 231 - 238. [Full Text] [PDF]
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O. H. Cingolani, X.-P. Yang, M. A. Cavasin, and O. A. Carretero Increased Systolic Performance With Diastolic Dysfunction in Adult Spontaneously Hypertensive Rats Hypertension, February 1, 2003; 41(2): 249 - 254. [Abstract] [Full Text] [PDF]
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M. Jessup The less familiar face of heart failure J. Am. Coll. Cardiol., January 15, 2003; 41(2): 224 - 226. [Full Text] [PDF]
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I. Sjaastad, J A. Wasserstrom, and O. M Sejersted Heart failure - a challenge to our current concepts of excitation-contraction coupling J. Physiol., January 1, 2003; 546(1): 33 - 47. [Abstract] [Full Text] [PDF]
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