J Cardiovasc Ultrasound.  2009 Sep;17(3):86-95. 10.4250/jcu.2009.17.3.86.

Therapeutic Strategies for Diastolic Dysfunction: A Clinical Perspective

• Ha JW
• Oh JK

• KMID: 1473732
• DOI: http://doi.org/10.4250/jcu.2009.17.3.86

Abstract

Diastolic dysfunction, which is increasingly viewed as being influential in precipitating heart failure and determining prognosis, is often unrecognized and has therapeutic implications distinct from those that occur with systolic dysfunction. In this review, several therapeutic modalities including pharmacologic, nonpharmacologic, and surgical approaches for primary diastolic dysfunction and heart failure will be discussed.

Keyword

Diastolic dysfunction; Therapy

MeSH Terms

Heart Failure
Prognosis

Figure

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  Fig. 1 A: Mitral inflow and annular velocities during the acute episode of shortness of breath with severe hypertension. The E/A ratio > 1.5, shortened deceleration time and reduced early diastolic mitral annular velocity suggestive of pseudonormal mitral inflow pattern. E/E' ratio of 33 indicating elevated left ventricular filling pressures. B: Transmitral inflow velocity after normalization of blood pressure (130/80 mmHg). The E/A ratio < 1 and prolonged deceleration time indicating delayed relaxation, more improved diastolic dysfunction. E: early diastolic mitral flow velocity, A: mitral flow velocity during atrial contraction, E': early diastolic mitral annular velocity, A': mitral annular velocity during atrial contraction.

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  Fig. 2 Doppler echocardiographic finding of mitral flow velocity in different atrioventricular interval. Note the separation of early and late filling velocities at shorter atrioventricular interval. AV: artrial ventricular.

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  Fig. 3 Schematic diagram illustrating therapeutic approaches based on the degree of diastolic dysfunction. LV: left ventricle, LVH: left ventricular Hypertrophy, DM: diabetes mellitus, CAD: coronary artery disease, DOE: dyspnea on exertion, ACE: angiotensin converting enzyme, ARB: angiotensin receptor blocker, NYHA: New York Heart Association, HF: heart failure.

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