Diastolic heart failure

Classification according to ICD-10
I50.1-	Left heart failure
	Diastolic heart failure
I50.11	Without complaints (NYHA stage I)
I50.12	With complaints under heavy exertion (NYHA stage II)
I50.13	With complaints under lighter stress (NYHA stage III)
I50.14	With complaints at rest (NYHA stage IV)
I50.19	Not further described
I11.0	Hypertensive heart disease with (congestive) heart failure ICD-10-GM
ICD-10 online (WHO version 2019)

The diastolic heart failure , and heart failure with preserved systolic pump function (HFpEF of Engl. Heart failure with preserved ejection fraction) or heart failure with preserved systolic left ventricular function , is a form of left ventricular failure . When diastolic heart failure occurs with or as a result of arterial hypertension (high blood pressure), it is also known as hypertensive heart disease .

In diastolic heart failure, there is a functional disorder in the relaxation phase of the heart ( diastole ). The pumping function of the heart ( systole ) is not or only slightly impaired.

Asymptomatic diastolic dysfunction is a precursor to diastolic heart failure.

distribution

Between 22 and 73% of all patients with symptoms of heart failure suffer from an isolated diastolic dysfunction.

root cause

The human heart

Diastolic heart failure is defined as increased filling resistance, primarily of the left ventricle, with normal systolic pump function.
The heart chamber either has a limited active relaxation ability (relaxation) u. a. as a consequence of

Circulatory disorder ( ischemia ),
Wall thickness increase ( hypertrophy due to high blood pressure , pressure load in the case of heart valve diseases , hypertrophic cardiomyopathy ) or

Aging

or a reduced passive elasticity ( compliance ) z. B. due

a scar as a result of a previous heart attack or
a restrictive cardiomyopathy (such as those at a amyloidosis can occur)

Symptoms

Diastolic heart failure cannot be distinguished from systolic heart failure on the basis of symptoms alone . However, if there are clear signs of heart failure , but the heart's pumping ability is not reduced ( ejection rate EF> 50%), this makes diastolic heart failure likely.

The symptoms of diastolic heart failure are primarily caused by the low cardiac output with limited filling of the stiffened left ventricle (left ventricle).

diagnosis

Diagnosing diastolic heart failure is sometimes complex and requires some complementary procedures. Echocardiography is of central importance in the diagnosis of diastolic heart failure .

In diastolic heart failure, left ventricular end-diastolic pressure (LVEDP) is increased. Left ventricular end-diastolic volume (LVEDV) is normal or decreased. The heart rate remains unchanged or is decreased. The amount of blood ejected ( ejection fraction ) is normal or increased (EF> 50%).

In addition, echocardiography for diastolic heart failure can be used to collect very special and therefore diagnosis-confirming measured values and a severity classification can be made regardless of the NYHA classification :

I normal
II relaxation disorder
III pseudo normalization
IV Restrictive
- IVa: reversible
- IVb: irreversible.

Pressure-volume curve

In the pressure-volume curve of the left ventricle (see picture), diastolic heart failure causes a shift upwards and to the left as the disease progresses, depending on the increasingly reduced ventricular compliance.

forecast

If the increased left ventricular end-diastolic pressure (LVEDP) creates a back pressure in the left atrium and pulmonary veins , this can lead to cardiac decompensation with dyspnoea and peripheral edema up to pulmonary edema .

treatment

The drugs that are effective in the treatment of systolic heart failure ( ACE inhibitors , AT1 receptor blockers , beta blockers ) are ineffective in diastolic heart failure. In one study, the drug spironolactone showed an improvement in diastolic myocardial function, a decrease in hypertrophy and the laboratory marker for heart failure ( NTproBNP ), but without any improvement in symptoms or performance. Especially people with advanced diastolic heart failure have been able to benefit from spironolactone in terms of hospitalization and prognosis.

Individual evidence

↑ ^a ^b The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology: 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure , European Heart Journal, 37 (27), 14. July 2016, 2129–2200, Retrieved October 3, 2018.
↑ ^a ^b ^c ^d ^e Irene Miekusch: Österreichische Ärztezeitung , Diastolic Heart Failure. Retrieved July 26, 2016.
^ GP Aurigemma, WH Gaasch: Clinical practice. Diastolic heart failure. In: N Engl J Med. 2004; 351, p. 1097.
↑ DL Brutsaert, SU Sys, TC Gillebert: Diastolic failure: pathophysiology and therapeutic implications. In: J Am Coll Cardiol. 1993; 22, p. 318.
^ GP Aurigemma: Diastolic heart failure - a common and lethal condition by any name. In: N Engl J Med. 2006; 355, p. 308.
↑ DGK , press text DGK 04/2014, first drug therapy success: Diastolic heart muscle weakness can be influenced. Retrieved July 27, 2016.

[ESC2016-1] The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology: 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure , European Heart Journal, 37 (27), 14. July 2016, 2129–2200, Retrieved October 3, 2018.

[Ärztezeitung.at_1-2] Irene Miekusch: Österreichische Ärztezeitung , Diastolic Heart Failure. Retrieved July 26, 2016.

[3] GP Aurigemma, WH Gaasch: Clinical practice. Diastolic heart failure. In: N Engl J Med. 2004; 351, p. 1097.

[4] DL Brutsaert, SU Sys, TC Gillebert: Diastolic failure: pathophysiology and therapeutic implications. In: J Am Coll Cardiol. 1993; 22, p. 318.

[5] GP Aurigemma: Diastolic heart failure - a common and lethal condition by any name. In: N Engl J Med. 2006; 355, p. 308.

[DGK_1-6] DGK , press text DGK 04/2014, first drug therapy success: Diastolic heart muscle weakness can be influenced. Retrieved July 27, 2016.