Diastolic heart failure: Difference between revisions
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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 protected]&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 protected]&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 protected]&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== | ||
Revision as of 11:05, 1 March 2010
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."[1]
Up to 40% of patients with heart failure may not have evidence of systolic dysfunction.[2]
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).[3]
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.[4]
Echocardiography may grade the severity of diastolic dysfunction, parameters include:[5]
- 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.[6]
Prognosis
Diastolic dysfunction, even in the absence of clinical heart failure, increases mortality.[7]
References
- ↑ Anonymous (2024), Diastolic heart failure (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ 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.
- ↑ 3.0 3.1 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