Diastolic Heart Failure (eBook)

Otto A. Smiseth, Michal Tendera (Herausgeber)

eBook Download: PDF

2008 | 2008
XIII, 349 Seiten
Springer London (Verlag)
978-1-84628-891-3 (ISBN)

Infos

Heart failure is the biggest killer in the western world, and the prevalence is expected to increase due to aging of the population. Over the past decade there has been an increasing awareness of left ventricular (LV) diastolic dysfunction as a mechanism of congestive heart failure. This book provides the clinician with essential insights into the epidemiology and aetiology of diastolic heart failure, and will enable them to understand how the condition can be diagnosed. Furthermore, the book will provide insights in cardiac function that are needed to perform and interpret the diagnostic tests, and to provide some guides to treatment choices.

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Heart failure is the biggest killer in the western world, and the prevalence is expected to increase due to aging of the population. Over the past decade there has been an increasing awareness of left ventricular (LV) diastolic dysfunction as a mechanism of congestive heart failure, and it appears that more than 30-40 % of all heart failure patients have dominantly diastolic heart failure, with preserved or only mildly reduced systolic function. Recent clinical studies suggest that patients with congestive heart failure and preserved LV function may benefit from specific medical treatment. Furthermore, in patients with hypertension the presence of diastolic dysfunction is a sign that the myocardium has reacted to the elevated blood pressure, and might indicate the need for intensified antihypertensive therapy. In spite of all this there are very few textbooks that provides the knowledge that would be needed in cardiology practice to approach and deal with patients with diastolic heart failure.There is, however, significant disagreement regarding the clinical value of assessing diastolic function, and the practising cardiologist is confused by the non-invasive methodology which includes a myriad of Doppler-based indices, and most of these are strongly dependant on age and cardiac loading conditions. Recent advances in non-invasive cardiac diagnostics, and in particular tissue Doppler echocardiography provides better and simpler diagnostic algorithm. However, in order to interpret the diagnostic methods the cardiologist should understand some fundamental concepts which relate to the physiology of cardiac filling. Current literature suggests that assessment of diastolic function may be clinically useful to make the diagnosis diastolic heart failure in patients who present with congestive heart failure and normal LV ejection fraction, and to provide a non-invasive estimate of LV diastolic pressure. Quantification of diastolic function also provides prognostic information that may be important. Furthermore, assessment of diastolic filling is very useful in the evaluation of patients suspected of constrictive pericarditis and in differentiating between constriction and restriction.

Inhalt

Preface 7
Contents 9
Contributors 11
Pathophysiology 15
Molecular Mechanisms of Diastolic Dysfunction 16
Introduction 16
Pathophysiology of Diastolic Dysfunction and Failure at the Level of the Ventricular Muscular Pump 16
Molecular Mechanisms of Impaired Ventricular Relaxation and Decreased Ventricular Compliance 18
Is Diastolic Heart Failure a Distinct Disease Entity? 22
Diastolic Heart Failure and Alternative Paradigms of Chronic Heart Failure 24
Conclusion 28
Pathophysiologic Aspects of Myocardial Relaxation and End- Diastolic Stiffness of Cardiac Ventricles 34
Introduction 34
Cardiovascular Congestion 34
The Cardiac Cycle, Systole and Diastole 36
Myocardial Relaxation and Its Time Course 40
End-Diastolic Properties of Muscle and Heart 43
Ventricular Arterial Coupling and Diastolic Heart Failure 47
Summary 49
Ventricular Interaction via the Septum and Pericardium 54
Introduction 54
Transmural Pressure 54
Ventricular Septum 57
Ventricular Interaction 57
Pulmonary Hypertension — The Common Denominator 58
Acute Pulmonary Hypertension 58
Chronic Pulmonary Hypertension 60
Congestive Heart Failure 60
Ventricular Interaction During Mechanical Ventilation 62
Conclusion 63
Role of the Left Atrium 66
Introduction 66
Basic Mechanical Function of the Left Atrium 66
The Atrium as a Control Center 66
How the Atrium Interacts with Ventricular Filling 67
Pathophysiology of Ventricular Filling and Involvement of the Left Atrium in Diastolic Dysfunction 71
Elasticity, Stiffness, and Atrial Remodeling 73
Cellular Pathophysiology of Atrial Remodeling 75
Importance of Left Atrial Volume as a Prognostic Index 76
Atrial Fibrillation, Left Atrium, and Diastolic Dysfunction 77
Relationships Among Mitral Insufficiency, Left Atrial Cavity, and Ventricular Dysfunction 78
Conclusion 78
Role of Neurohormones and Peripheral Vasculature 84
Introduction 84
Role of Neurohormonal Activation 84
Role of the Vascular System 90
Filling Velocities as Markers of Diastolic Function 94
Introduction 94
Pulmonary Venous Flow Velocities 94
Transmitral Flow Velocities 99
Intraventricular Filling 104
Myocardial Velocities as Markers of Diastolic Function 112
Relationship Between Myocardial Velocities and Diastolic Function 112
Clinical Methods of Assessing Myocardial Velocities 112
Clinical Interpretation of Myocardial Velocities 119
Myocardial Velocities and Grading of Diastolic Dysfunction 120
Abnormal Diastolic Velocities as Early Markers of Subclinical Myocardial Disease 121
Asynchrony of Local Diastolic Function 122
Prognostic Significance of Tissue Doppler Parameters 123
Diastolic Deformation Indexes 124
Diastolic Versus Systolic Heart Failure 132
Introduction 132
Left Ventricular Systolic and Diastolic Performance 132
Definition of Systolic and Diastolic Heart Failure 134
Left Ventricular Structure and Function in Systolic and Diastolic Heart Failure 134
Exercise Intolerance 139
Distinction Between Systolic and Diastolic Heart Failure 142
Diagnosis of Diastolic Heart Failure 148
Invasive Evaluation of Diastolic Left Ventricular Dysfunction 150
Introduction Left Ventricular Relaxation Kinetics 150
Left Ventricular Diastolic Distensibility 153
Left Ventricular Diastolic Stiffness 155
Diastolic Myocardial or Muscle Stiffness 156
Conclusion 158
Echocardiographic Assessment of Diastolic Function and Diagnosis of Diastolic Heart Failure 162
Introduction 162
Two-Dimensional Echocardiography 162
Doppler Echocardiography 163
Classification of Diastolic Function 169
Diagnosis of Diastolic Heart Failure 172
Magnetic Resonance Imaging 176
Introduction 176
Technique 176
Complementary to Echocardiography 179
Specific to Cardiovascular Magnetic Resonance 180
Problems 183
Future Applications 184
Natriuretic Peptides in the Diagnosis of Diastolic Heart Failure 188
Introduction 188
Structure and Mechanisms of Natriuretic Peptides 188
Choice of Natriuretic Peptide in the Clinical Setting 191
Diastolic Dysfunction in the General Population 191
Diastolic Heart Failure 193
Diastolic Heart Failure and Hypertension 193
Decompensated Diastolic Heart Failure 194
Combined Diastolic and Systolic Heart Failure 194
Impact of Treatment on Brain Natriuretic Peptide Levels 195
Special Populations 195
Guidelines 195
Conclusion 196
Noninvasive Estimation of Left Ventricular Filling Pressures 200
Introduction 200
Left Ventricular Filling Pressures 200
Mitral Inflow 201
Pulmonary Venous Flow 203
Isovolumic Relaxation Time 204
New Indices of Left Ventricular Relaxation for Prediction of Left Ventricular Filling Pressures 204
Other Echocardiographic Correlates of Left Ventricular Filling Pressures 208
Estimation of Left Ventricular Filling Pressures According to Left Ventricular Ejection Fraction 209
Doppler Estimation of Filling Pressures in Sinus Tachycardia Doppler Estimation of Filling Pressures in Atrial Fibrillation 210
Doppler Estimation of Left Ventricular Filling Pressures in Patients with Mitral Valve Disease 211
Conclusion 212
Epidemiology, Prognosis, and Treatment 216
Epidemiology of Diastolic Heart Failure 218
Introduction 218
Incidence 218
Prevalence 219
Subpopulations 222
Limitations of the Epidemiological Studies Investigating the Prevalence of Heart Failure with Normal Ejection Fraction 224
Conclusion 224
Prognosis in Diastolic Heart Failure 226
Introduction 226
Mortality 226
Hospital Admissions 231
Remaining Questions and Conclusion 232
Treatment of Diastolic Heart Failure 236
Introduction 236
Chronic Heart Failure 236
Acute Heart Failure 248
Conclusion 249
Specific Disease-Related Problems in Diastolic Heart Failure 254
Coronary Artery Disease and Diastolic Left Ventricular Dysfunction 256
Introduction 256
Ischemia 257
Pathophysiology 257
Materials and Methods 258
Results 260
Discussion 265
Conclusion 272
Hypertension and Diastolic Function 276
Introduction 276
Background 276
Definition of Diastolic Dysfunction 278
Pathophysiology of Diastolic Dysfunction in Hypertension 278
Neurohumoral Adaptation and Diastolic Function in Hypertension 280
Diastolic Disturbances in Diabetes Mellitus 284
Introduction 284
Manifestations of Myocardial Dysfunction in Diabetes 284
Pathogenesis of Diabetic Heart Disease 288
Clinical Presentation of Diabetic Heart Disease 290
Therapeutic Implications in the Diabetic Heart 291
Conclusion 292
Hypertrophic Cardiomyopathy 298
Introduction 298
The Hypertrophic Cardiomyopathies 299
Left Ventricular Filling and Preload Reserve 304
Diastolic Abnormalities in Hypertrophic Cardiomyopathy 306
Clinical Significance of Diastolic Abnormalities in Hypertrophic Cardiomyopathy 311
Measurement Tools and Prospective Intervention Strategies 314
Constrictive Pericarditis and Restrictive Cardiomyopathy 324
Introduction 324
Constrictive Pericarditis 324
Restrictive Cardiomyopathy 334
New Invasive Hemodynamic Features to Differentiate Constriction From Restriction 337
Endomyocardial Biopsy 338
Conclusion 338
Summary 342
Definition and Epidemiology of Diastolic Heart Failure 342
Etiology of Diastolic Heart Failure 343
Aging and Left Ventricular Diastolic Function 344
How to Diagnose Diastolic Heart Failure 345
Invasive Methods 345
Noninvasive Methods 346
Differential Diagnosis 349
Why Assess Diastolic Function in Systolic Heart Failure? 349
Prognosis and Treatment 349
Index 352

Produkt-Details

• Erscheint lt. Verlag: 16.4.2008
• Zusatzinfo: XIII, 349 p.
• Verlagsort: London
• Sprache: englisch
• Themenwelt: Medizinische Fachgebiete ► Innere Medizin ► Kardiologie / Angiologie
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Notfallmedizin
• Schlagworte: cardiac function • Cardiology • Diabetes • Diabetes mellitus • Diagnostics • Hypertension
• ISBN-10: 1-84628-891-6 / 1846288916
• ISBN-13: 978-1-84628-891-3 / 9781846288913