Burden of Systolic and Diastolic Ventricular Dysfunction in the Community

Abstract

ONGESTIVE HEART FAILURE(CHF) is a clinical syndrome defined by characteristic symptoms and physical findings. Echocardiography is often performed in patients with CHF to measure the ejection fraction (EF) and determine if systolic function is reduced, systolic CHF or preserved, diastolic CHF. Comprehensive Doppler echocardiography can now characterize diastolic function directly in addition to measurement of the EF.Cardiovascular diseases (CVDs) such as hypertension, coronary artery disease, and cardiomyopathies often lead to systolic and diastolic ventricular dysfunction. Nearly all patients with systolic dysfunction have some degree of concomitant diastolic dysfunction, specifically, impaired relaxation and variable decreases in ventricular compliance. 1 However, it is now recognized that patients with normal EF can display marked impairment in diastolic function (isolated diastolic dysfunction). 2 Clinically, it has been recognized that some patients with advanced systolic dysfunction remain free of symptoms of CHF. Thus, individuals may have systolic dysfunction without receiv-

Clinical Phenotypes in Heart Failure With Preserved Ejection Fraction

“…Both are major determinants of PH in patients with HFrEF 159. All patients with HFrEF have some degree of functional mitral regurgitation and LVDD as their condition deteriorates 9, 160. However, only 60% of patients with advanced HFrEF develop PH 152.…”

“…Over the past 2 decades, the syndrome of heart failure with preserved ejection fraction (HFpEF) received a lot of attention 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19. However, little therapeutic progress was made 20, 21, 22, 23, 24, 25, 26, 27.…”

“…As a whole, HFpEF has been extensively reviewed 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19. The present review focuses on 4 commonly encountered clinical phenotypes of HFpEF and their comorbid conditions (Figure).…”

Conventional and Ambulatory Blood Pressure as Predictors of Diastolic Left Ventricular Function in a Flemish Population

“…Among 793 Flemish followed up for 5 years, the multivariable‐adjusted hazard ratios per 1‐SD decrease ( P =0.001) in e′ amounted to 2.50 and 3.66 for cardiovascular and cardiac complications, respectively 33. Furthermore, in 2042 participants enrolled in the Olmsted County Study34 and followed up for 3.5 years, mild (20.8%) and moderate‐to‐severe (7.3%) diastolic LV dysfunction at baseline predicted all‐cause mortality with hazard ratios of 8.3 and 10.2 ( P <0.001). In the Framingham Heart Study, remote blood pressure (average of all reading 11–20 years before current) and recent blood pressure (average of all reading 1–10 years before current) predicted the risk of cardiovascular disease incrementally over current blood pressure 35.…”

CYP 2J2 and its metabolites (epoxyeicosatrienoic acids) attenuate cardiac hypertrophy by activating AMPK α2 and enhancing nuclear translocation of Akt1

“…In a recent population‐based study in US, the prevalence of heart failure was 2.2% (95 CI 1.6–2.8%), increasing from 0.7% in persons aged 45 through 54 years to 8.4% for those aged 75 years or older (Redfield et al ., 2003). Neurohormonal dysregulation (such as increased Ang II levels) in aged heart may somehow explain why the 5‐year risk rate of cardiac hypertrophy and heart failure was higher in older persons.…”