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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Diastolic heart failure (DHF) is estimated to occur in 40% to 50% of patients with heart failure. Evidence suggests that DHF is primarily a cardiogeriatric syndrome that increases from approximately 1% at age 50 years to 10% or more at 80 years. DHF is also more likely to occur in older women who are hypertensive or diabetic. Although survival is better in patients with DHF compared with systolic heart failure, mortality rates for patients with DHF are four times higher than those for healthy, community-dwelling older adults. The increase in DHF is anticipated to continue during the next several decades largely because of the aging of the population; increase in risk factors associated with hypertension, diabetes, and obesity; and ongoing technologic advances in the treatment of cardiovascular disease. Few clinical trials have evaluated therapy in this population, so evidence about the effectiveness of treatment strategies for DHF is limited. Future research should target novel interventions that specifically target patients with DHF who are typically older and female, and experience exertional intolerance and have a considerably reduced quality of life.
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PMID:Diastolic heart failure. 1899 23

Diastolic heart failure is a frequent diagnosis, but now it is more acurate to call this heart failure with preserved ejection fraction. The diagnosis can be made non invasively by the echocardiography and measuring BNP (brain natriuretic peptide). Consensus about treatment are less evidence-based than for heart failure with diminished ejection fraction. It is however certain that control of hypertension and heart rate are important. Fluid overload must also be treated with diuretics.
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PMID:[Diastolic heart failure: myth or fact?]. 1902 72

Diastolic heart failure (DHF) or heart failure with preserved systolic left ventricular function is estimated to account for approximately 40% of heart failure cases. Medical treatment of patients with DHF is limited and mainly empirical. Device-based therapy has an increasing role in the treatment of systolic heart failure and may have a future role in the treatment of DHF patients. Diastolic dysfunction and DHF are associated with anatomical and physiological characteristics, which need to be modeled in large animals in order to allow evaluation of device-based therapies, prior to clinical studies. In this article, we will review the large animal models for diastolic dysfunction and heart failure.
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PMID:Large animal models for diastolic dysfunction and diastolic heart failure-a review of the literature. 1921 Dec 73

Data from 519 patients older than 65 years with congestive heart failure (CHF) were analyzed after 5 years of clinical follow-up. Two groups were included in the analysis: 321 patients with ejection fractions > or =50% (group with diastolic heart failure) and 198 patients with reduced ejection fraction <50% (group with systolic heart failure). Hypertension (81%) was the strongest predictor of congestive heart failure, followed by diabetes (46%) and coronary disease (33%). Diastolic heart failure was more predominant in elderly female (P=.007), hypertensive (P=.0001), and hypertrophic (P=.001) patients. Length of hospital stay, readmission rate, all-cause morbidity, and cumulative mortality were not statistically significant between both groups (P=.09).
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PMID:The prevalence, clinical characteristics, and prognosis of diastolic heart failure: a clinical study in elderly Saudi patients with up to 5 years follow-up. 1952 60

Echocardiography with Doppler is the most commonly performed non-invasive cardiac imaging test in patients with suspected or documented heart failure (HF), and plays a pivotal role in their assessment and management. Two- and three-dimensional echocardiography are commonly used to quantitatively assess cardiac volumes, left ventricular ejection fraction (LVEF), stroke volume and cardiac output. Resting and stress echocardiography the latter with exercise or pharmacologic stress play a fundamental role in distinguishing ischemic from non-ischemic etiology of HF and in demonstrating myocardial viability. Echocar-diography with comprehensive spectral and color Doppler can accurately determine if valve disease plays a primary or secondary role in HF etiology. Diastolic heart failure (DHF) also termed HF with a preserved LVEF is readily identified by echocardiography with Doppler, and can accurately estimated LV filling pressures and pulmonary artery pressures. The right ventricle can also be readily assessed by echocardiography, with newer techniques such as three-dimensional, tissue Doppler and speckle strain imaging aiding its assessment. Echocardiography is also commonly used to identify candidates for implantable cardiac defibrillator and cardiac resynchronization therapies. Three-dimensional echocardiography now easily preformed with single-beat full volume capture promises to further refine HF diagnosis. Finally, speckle-based strain and strain rate, and three-dimensional speckle imaging, are more novel techniques that can shed light on detailed myocardial mechanics in patients with depressed or preserved LVEF.
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PMID:Echocardiography in the assessment of heart failure. 1976 68

Diastolic heart failure (DHF) is present in over 50% of hospitalized heart failure patients, and diastolic dysfunction is known to play a critical pathophysiologic role. Measurement of left-ventricular pressure (LVP) via catheterization is the gold standard for diastolic function (DF) evaluation, but current methods fail to fully capitalize on the complete information content of the pressure contour. We have previously demonstrated that a kinematic model of isovolumic pressure decay (IVPD), which accounts for restoring force (stiffness) and resistance (viscoelasticity/relaxation), provides mechanistic insight into IVPD physiology and provides an accurate fit to the recorded contour. Recently we derived a novel load-independent index of isovolumic pressure decay (LIIIVPD) involving IVPD kinematic model stiffness and resistance parameters. In this work we detail methods and provide guidelines by which LIIIVPD computation may be achieved in real-time from the pressure contour recorded during cardiac catheterization.
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PMID:Automated method for calculation of a load-independent index of isovolumic pressure decay from left ventricular pressure data. 1996 79

Diastolic heart failure is a common clinical entity that is indistinguishable from systolic heart failure without direct evaluation of left ventricular function. Diastolic heart failure is a clinical diagnosis in patients with signs and symptoms of heart failure but with preserved left ventricular function and normal ejection fraction, and is often seen in patients with a long-standing history of hypertension or infiltrative cardiac diseases. In contrast, diastolic dysfunction represents a mechanical malfunction of the relaxation of the left ventricular chamber that is primarily diagnosed by two-dimensional transthoracic echocardiography and usually does not present clinically as heart failure. The abnormal relaxation is usually separated in different degrees, based on the severity of reduction in passive compliance and active myocardial relaxation. The question whether diastolic dysfunction ultimately will lead to diastolic heart failure is critically reviewed, based on data from the literature. Treatment recommendations for diastolic heart failure are primarily targeted at risk reduction and symptom relief. Currently, few data only are reported on diastolic dysfunction and its progression to systolic heart failure.
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PMID:The clinical quandary of left and right ventricular diastolic dysfunction and diastolic heart failure. 2083 21

A nuclear cardiology test is the most commonly performed non-invasive cardiac imaging test in patients with heart failure, and it plays a pivotal role in their assessment and management. Quantitative gated single positron emission computed tomography (QGS) is used to assess quantitatively cardiac volume, left ventricular ejection fraction (LVEF), stroke volume, and cardiac diastolic function. Resting and stress myocardial perfusion imaging, with exercise or pharmacologic stress, plays a fundamental role in distinguishing ischemic from non-ischemic etiology of heart failure, and in demonstrating myocardial viability. Diastolic heart failure also termed as heart failure with a preserved LVEF is readily identified by nuclear cardiology techniques and can accurately be estimated by peak filling rate (PFR) and time to PFR. Movement of the left ventricle can also be readily assessed by QGS, with newer techniques such as three-dimensional, wall thickening evaluation aiding its assessment. Myocardial perfusion imaging is also commonly used to identify candidates for implantable cardiac defibrillator and cardiac resynchronization therapies. Neurotransmitter imaging using (123)I-metaiodobenzylguanidine offers prognostic information in patients with heart failure. Metabolism and function in the heart are closely related, and energy substrate metabolism is a potential target of medical therapies to improve cardiac function in patients with heart failure. Cardiac metabolic imaging using (123)I-15-(p-iodophenyl)3-R, S-methylpentadecacoic acid is a commonly used tracer in clinical studies to diagnose metabolic heart failure. Nuclear cardiology tests, including neurotransmitter imaging and metabolic imaging, are now easily preformed with new tracers to refine heart failure diagnosis. Nuclear cardiology studies contribute significantly to guiding management decisions for identifying cardiac risk in patients with heart failure.
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PMID:Clinical use of nuclear cardiology in the assessment of heart failure. 2116 Jun 12

Diastolic heart failure, also termed as heart failure with normal or preserved ejection fraction has a high prevalence and mortality world wide. The clinical manifestation comprises typical symptoms and signs of heart failure along with normal or discretely reduced left ventricular ejection fraction. Though the etiology of diastolic heart failure is incompletely understood, functional and structural abnormalities of cardiomyocytes, the extracellular matrix, and the peripheral vasculature are assumed to contribute to the etiology of diastolic heart failure. The diagnosis requires typical symptoms and signs of heart failure, evidence of elevated natriuretic peptides and an impaired diastolic ventricular function, meanwhile left ventricular systolic function is normal or just slightly impaired. Catheter and MRI exams help to ensure the diagnosis. So far, no therapy has convincingly demonstrated a reduction of morbiditiy and mortality. Therefore, current guidelines emphasize the importance of an adequate treatment of risk factors and myocardial ischemia.
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PMID:[Diagnosis and therapy of heart failure with normal ejection fraction]. 2127 38

Epidemiologic as well as clinical studies confirm the close link between diabetes mellitus and heart failure. Diabetic cardiomyopathy (DCM) is still a poorly understood "entity", however, with several contributing pathogenetic factors which lead in different stages of diabetes to characteristic clinical phenotypes. Hyperglycemia with a shift from glucose metabolism to increased beta-oxidation and consecutive free fatty acid damage (lipotoxicity) to the myocardium, insulin resistance, renin-angiotensin-aldosterone system (RAAS) activation, altered calcium homeostasis and structural changes from the natural collagen network to a stiffer matrix due to advanced glycation endproduct (AGE) formation, hypertrophy and fibrosis contribute to the respective clinical phenotypes of DCM. We propose the following classification of cardiomyopathy in diabetic patients: a) Diastolic heart failure with normal ejection fraction (HFNEF) in diabetic patients often associated with hypertrophy without relevant hypertension. Relevant coronary artery disease (CAD), valvular disease and uncontrolled hypertension are not present. This is referred to as stage 1 DCM. b) Systolic and diastolic heart failure with dilatation and reduced ejection (HFREF) in diabetic patients excluding relevant CAD, valvular disease and uncontrolled hypertension as stage 2 DCM. c) Systolic and/or diastolic heart failure in diabetic patients with small vessel disease (microvascular disease) and/or microbial infection and/or inflammation and/or hypertension but without CAD as stage 3 DCM. d) If heart failure may also be attributed to infarction or ischemia and remodeling in addition to stage 3 DCM the term should be heart failure in diabetes or stage 4 DCM. These clinical phenotypes of diabetic cardiomyopathy can be separated by biomarkers, non-invasive (echocardiography, cardiac magnetic resonance imaging) and invasive imaging methods (levocardiography, coronary angiography) and further analysed by endomyocardial biopsy for concomitant viral infection. The role of specific diabetic drivers to the clinical phenotypes, to macro- and microangiopathy as well as accompanying risk factors or confounders, e.g. hypertension, autoimmune factors or inflammation with or without viral persistence, need to be identified in each individual patient separately. Thus hyperglycemia, hyperinsulinemia and insulin resistance as well as lipotoxicity by free fatty acids (FFAs) are the factors responsible for diabetic cardiomyopathy. In stage 1 and 2 DCM diabetic cardiomyopathy is clearly a fact. However, precise determination of to what degree the various underlying pathogenetic processes are responsible for the overall heart failure phenotype remains a fiction.
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PMID:Diabetic cardiomyopathy--fact or fiction? 2142 47


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