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.
There is no product currently available that will provide the reader with a comprehensive evaluation of diastolic function
The prevalence of heart failure is increasing and yet a significant proportion of these patients have normal left ventricular (LV) systolic function. In these patients with diastolic dysfunction, heart failure is frequently referred to as diastolic heart failure. While the majority of research into heart failure has concentrated on those patients with LV systolic dysfunction, heart failure patients with preserved systolic function have been grossly underinvestigated. It is critical not only to continue to research and treat those patients with LV systolic dysfunction but also to investigate the possibilities in those patients with diastolic dysfunction with a view to providing tailored management of heart failure for all patients.
This book is the first to give a comprehensive overview not only of the diastolic heart failure, but also of different aspects of LV diastolic function in general. It addresses the epidemiology, pathophysiologic mechanisms, diagnostic methods, treatment and prognosis. It also gives an analysis of specific problems, related to coronary artery disease, arterial hypertension, diabetes, hypertrophic and restrictive cardiomyopathies, and constrictive pericarditis.
The aim of the Editors and their world-class panel of contributing authors has been not only to summarize the existing knowledge on the role of diastolic dysfunction in heart failure but also to identify the gaps in the understanding of the problem and stimulate discussion in these areas. Consequently, this book will prove useful for both basic scientists and clinicians involved in research and clinical care of patients with heart failure. As such, cardiologists, internists and all disciplines involved in the management of this group of patients will benefit from reading this book.
Introduction.- Molecular mechanisms of diastolic dysfunction.- Pathophysiological aspects of myocardial relaxation and end-diastolic stiffness of cardiac ventricles.- Ventricular interactions via the septum and pericardium.- The role of the left atrium.- The role of neurohormones and peripheral vasculature.- Filling velocities as markers of diastolic function.- Myocardial velocities as markers of diastolic function.- Diastolic versus systolic heart failure.- Invasive evaluation of diastolic left ventricular dysfunction.- Echocardiographic assessment of diastolic function and diagnosis of diastolic heart failure.- Magnetic resonance imaging.- Natriuretic peptides in diagnosis of diastolic heart failure.- Noninvasive estimation of left ventricular filling pressures.- Epidemiology of Diastolic Heart Failure.- Prognosis in Diastolic Heart Failure.- Treatment of Diastolic Heart Failure.- Coronary artery disease and diastolic left ventricular dysfunction.- Hypertension and diastolic function.- Diastolic disturbances in diabetes mellitus.- Hypertrophic cardiomyopathy.- Constrictive pericarditis and restrictive cardiomyopathy.- Summary.