ADVANCES IN PATHOPHYSIOLOGY AND MANAGEMENT OF DIASTOLIC HEART FAILURE


Kanu Chatterjee, M.B., FRCP, The Carver College of Medicine, University of Iowa, Iowa City, IA, USA

Diastolic heart failure is defined as asyndrome of heart failure with preserved ejection fraction (HFPREF). In diastolic heart failure, left ventricular wall thickness and mass is increased and the cavity size is normal. The mass/cavity ratio is increased. There is also a decrease in wall stress which contributes to maintain ejection fraction. The diastolic pressure volume relation curve shifts upwards and to the left. This causes a disproportionate increase in left ventricular diastolic pressure. With a marked upward and leftward shift of the diastolic pressure volume curve, left ventricular filling is compromised and stroke volume and cardiac output declines. The left ventricular wall architecture is disorganised and characterised by marked increase in fibrosis which makes the left ventricle stiffer. The myocyte diameter is increased without a change in its length. There is also increased protein synthesis. Diuretic treatment is necessary to relieve congestion. Spironolactone has the potential to reduce fibrosis. Sildenafil (PDE5 inhibitor) may improve symptoms, exercise tolerance. It also decreases pulmonary capillary wedge pressure and pulmonary artery pressure.