Diastolic heart failure -: pathophysiology

Background: Systolic dysfunction of the left ventricle is not the only mechanism of heart failure. An increasing number of patients are found to have heart failure with an ejection fraction greater than or equal to 40%. The proportion of heart failure patients with "diastolic" (or more appropriately preserved systolic function) heart failure increases with age. This clinical entity currently accounts for 30 to 40% of all hospitalizations for heart failure and in patients over 80 is found in more patients than is systolic dysfunction. Pathophysiology: Diastolic heart failure generally associates prolonged ventricular relaxation with reduced left ventricular capacity for distention. The main causes are ischemic, hypertensive and age-related heart disease. Concentric remodeling of the left ventricle, with or without hypertrophy, always leads to disatolic functional disorders. A triggering factor is almost always found for episodes of acute congestion. Conclusion: The incidence of "diastolic" heart failure increases with age. Physicians should be aware of the complex underlying pathophysioiogical mechanisms. (C) 2000 Masson, Paris.