Definitions Diastolic Dysfunction: Pathophysiologic condition associated with impaired myocardial relaxation and elevated LV filling pressure. Diastolic Heart Failure: Signs and symptoms of Heart Failure due to abnormalities in LV relaxation and or stiffness. HFpEF: Signs and symptoms of heart failure with preserved EF
Why the Need for a change in Semantics?
Aurigemma GP, et al. Circulation 2006; 113: 296–304 Systolic HF Normal heart Diastolic HF Pathophysiology
Figure 2 Trans-mitral valve spectral Doppler flow pattern in a normal subject (upper panel), in a patient with mild diastolic dysfunction (abnormal relaxation; middle panel), and in a patient with severe (restrictive) diastolic dysfunction (lower panel) Figure 2 Trans-mitral valve spectral Doppler flow pattern in a normal subject (upper panel), in a patient with mild diastolic dysfunction (abnormal relaxation; middle panel), and in a patient with severe (restrictive) diastolic dysfunction (lower panel) Clinical Science (2004) 107, Clinical Science (2004) 107,
Systolic vs. Diastolic Heart Failure Patients with systolic heart failure have parameters of diastolic dysfunction Elevated filling pressure, fibrosis Patients with diastolic heart failure do not have normal systolic function Diminished reserve Contractility does not increase exercise.
Treatment Recommendations COR LOE Control Systolic and Diastolic BP I B Diuretics for relief of symptoms I C Coronary Revascularization if symp IIa C Manage AFIB IIa C B blockers, ACEI, ARBs for HTN IIa C ARBs might reduce hospitalizations IIa B Nutritional Supplementations not rec. IIa C
Conclusions The terms systolic and diastolic heart failure: Do not adequately divide the heart failure population Are not based on actual pathophysiology
Conclusions HFpEF: Is a growing clinical problem in our aging population Etiology and pathophysiology are incompletely understood Associated with many comorbidities Poor prognosis No treatment has been demonstrated to directly alter outcome