Diastolic Dysfunction: Pathophysiology, Clinical Features, and Treatment

2005 ◽  
pp. 271-301
Author(s):  
Carl S. Apstein
Keyword(s):  
Diastolic Dysfunction ◽  
Clinical Features

P2604Clinical features associated with the development of diastolic dysfunction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S H Bots ◽  
G B Verschoor ◽  
F H Rutten ◽  
N C Onland-Moret ◽  
L Hofstra ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Diastolic Dysfunction ◽  
Diastolic Function ◽  
Clinical Features ◽  
Blood Lipid ◽  
Stepwise Logistic Regression ◽  
Men And Women ◽  
Adjusted Risk ◽  
Increased Risk ◽  
Pressure Lowering

Abstract Background/Introduction Treatment for heart failure with preserved ejection fraction (HFpEF) is still elusive, which is a serious problem given the fact that it affects approximately 8 million people in Europe. Diastolic dysfunction (DD) is considered a precursor of HFpEF and could serve as a target for prevention. However, it is yet unclear which clinical features are associated with the development of diastolic dysfunction in men and women. Purpose To determine which clinical features are associated with the development of diastolic dysfunction in men and women visiting a cardiology outpatient clinic. Methods All individuals who visited one of the 13 Cardiology Centers Netherlands locations at least twice between April and 2007 and February 2018 for an echocardiographic evaluation were eligible for inclusion. Participants with incomplete data on diastolic function parameters or diastolic dysfunction at baseline were excluded. Information on age, sex, body mass index (BMI), systolic blood pressure (SBP), blood lipid levels, kidney function, cardiac history, co-morbidities and cardiovascular drug use was obtained for all participants. Diastolic function was scored based on E/e', relative wall thickness (RWT) and left-atrial dimension indexed by body surface area (LAD/BSA). The score allotted zero points for E/e' ≤8, RWT ≤0.41 and LAD/BSA ≤2.3, one point for E/e' between 9–14, RWT >0.42 and LAD/BSA >2.3, and two points for E/e' ≥15. Development of DD was defined as an increase in diastolic function score between the first and second echo. Missing data on determinants (max 26%) was imputed using multiple imputation. A stepwise logistic regression based on AIC was applied to evaluate the association between selected clinical features and DD. All analyses were performed in R. Results The study population comprised 1301 patients with a mean age of 56 (± 11) years and 46% were women. The median time between echo appointments was 631 (IQR: 381–1132) days and 549 patients developed DD (42%). After stepwise regression, the final model included age, sex, BMI, SBP, triglycerides and hypertension. DD was less likely to occur in men compared with women (OR=0.62, 95% CI: 0.57–0.67), and more likely in patients with hypertension (OR=1.29, 95% CI: 1.18–1.42) after adjustment. The adjusted risk for DD increased with triglyceride level (OR=1.24, 95% CI: 1.19–1.29), age (OR=1.04 per year, 95% CI: 1.03–1.04), BMI (OR=1.03 per kg/m2, 95% CI: 1.01–1.04) and SBP (OR=1.01 per 1 mmHg, 95% CI: 1.006–1.011) (Figure 1). Figure 1 Conclusion(s) Women and those with hypertension were at higher risk of developing DD compared to their male or normotensive counterparts. Age, triglyceride levels, BMI and SBP were also independently associated with an increased risk for DD. Prevention efforts focussing on life style changed and possibly lipid and blood pressure lowering drugs may reduce the risk of developing DD.

scholarly journals Clinical Features Associated With Nascent Left Ventricular Diastolic Dysfunction in a Population Aged 40 to 55 Years

2018 ◽  
Vol 121 (12) ◽  
pp. 1552-1557 ◽  
Author(s):  
Jonathan D. Mosley ◽  
Rebecca T. Levinson ◽  
Evan L. Brittain ◽  
Deepak K. Gupta ◽  
Eric Farber-Eger ◽  
...  
Keyword(s):  
Diastolic Dysfunction ◽  
Clinical Features ◽  
Left Ventricular Diastolic Dysfunction ◽  
Left Ventricular ◽  
Ventricular Diastolic Dysfunction

Abstract 3076: Effects of Exercise on Ventricular Mechanical Dyssynchrony in Patients with Heart Failure Currently not Recommended for Resynchronization - Results from the Dyssynchrony Induced by Ventricular Exertion in Heart Failure (DIVE-HF) Study.

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Yi-Chih Wang ◽  
Chih-Chieh Yu ◽  
Juey-Jen Hwang ◽  
Ling-Ping Lai ◽  
Chia-Ti Tsai ◽  
...  
Keyword(s):  
Heart Failure ◽  
Diastolic Dysfunction ◽  
Clinical Features ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Resynchronization Therapy ◽  
Post Exercise ◽  
Ventricular Dyssynchrony ◽  
Bruce Protocol

Background. Resynchronization therapy has been proven to improve exercise tolerance only in heart failure (HF) patients (pts) with profoundly impaired left ventricular ejection fraction (LVEF). Whether it could be useful to other spectrum of HF pts may depend on the existence of ventricular dyssynchrony, either at rest or exercise-induced. Methods. We studied clinical features, ECG, and echocardiography coupled with tissue Doppler imaging (TDI) in 70 pts (38 men and 32 women, mean age 62±13 years). Among them, 60 pts with compensated HF (functional class II–III) for at least 3 months were grouped into systolic HF (SHF; EF=35–50 %, N=30) and diastolic HF (DHF; EF=50 % plus diastolic dysfunction, N=30) groups. The other 10 pts had no systolic or diastolic dysfunction are the control group. Six-minutes (stage 2) treadmill exercise tests were performed for SHF pts by modified Bruce protocol and for DHF and control pts by Bruce protocol. Dyssynchrony index (DI) represented by standard deviation of electromechanical delays of 12 LV segments was measured before and immediately after exercise. Results. Except for diverse clinical features and conventional echo-parameters as expected, the QRS duration was similar (mean: 93±16 ms) between the 3 groups. TDI studies showed that baseline synchronized LV contraction remained unchanged after exercise (DI: 12.4±3.6 vs. 11.8±2.9 ms, p =ns) in control group. With regard to the DHF group, the preexisting ventricular dyssynchrony got significantly exacerbated (DI: 52.4±10.0 vs. 62.4±12.8 ms, p< 0.001) including 21 pts (70%) with a ≥ 10% increase of DI after exercise provocation. With a more complex response to exercise, the DI in SHF pts didn’t worsen significantly (27.0±19.2 vs. 32.8±20.6 ms, p< 0.06). However, the proportion of DI>33 ms, considered as presence of dyssynchrony, increased from 37% at baseline to 50% after exercise, including 6 pts (20%) with post-exercise new development and 2 pts (7%) with post-exercise disappearance of ventricular dyssynchrony. Conclusions. Exercise-exacerbated ventricular dyssynchrony in DHF pts, and a 50% incidence of post-exercise dyssynchrony in SHF pts with LVEF between 35 to 50% may support the potential utility of resynchronization therapy to these non-indicated HF groups.

Fibrosing cholestatic hepatitis: Clinical features, outcome and response to interferon and ribavirin

2001 ◽  
Vol 120 (5) ◽  
pp. A563-A564
Author(s):  
M ISMAIL ◽  
I DABOUL ◽  
B WATERS ◽  
J FLECKENSTEIN ◽  
S VERA ◽  
...  
Keyword(s):  
Clinical Features ◽  
Cholestatic Hepatitis
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