Management of diastolic heart failure in older adults
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《英国医生杂志》
EDITOR—I agree with McCulloch that diagnosing diastolic heart failure is complex. A detailed discussion of this complex topic was beyond the scope of my brief review.
The third criterion of the European Study Group on Diastolic Heart Failure (evidence of abnormal left ventricular relaxation, filling, diastolic distensibility, and diastolic stiffness) is important yet impractical in routine clinical practice.1 Vasan et al proposed that a more practical "probable" diagnosis of diastolic heart failure may be made in patients with clinical heart failure and normal or near normal systolic function but no objective evidence of diastolic dysfunction.2 Accordingly, I said that a probable diagnosis of diastolic heart failure can be made if echocardiography shows preserved systolic function. I also said that documentation of an abnormal left ventricular relaxation pattern would be required for a more specific diagnosis. I mentioned the ratio of early (E) to late or atrial (A) ventricular filling velocities along with its limitations as it is one of the most commonly used echocardiographic indices for diastolic dysfunction. Discussion of the comparatively new tissue Doppler imaging technique was beyond the scope of this brief review for generalist doctors.
I also agree with Walsh about the potential for B-type natriuretic peptide as a diagnostic tool. However, its use in diagnosing diastolic dysfunction is still evolving and is not recommended by major heart failure guidelines.3 4 In managing complex problems such as heart failure with rapidly evolving diagnostic and therapeutic strategies, generalist doctors might best follow specific guideline recommendations.
Ali Ahmed, assistant professor
Division of Gerontology and Geriatric Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA aahmed@uab.edu
References
European Study Group on Diastolic Heart Failure How to diagnose diastolic heart failure. Eur Heart J 1998;19: 990-1003.
Vasan RS, Levy D. Defining diastolic heart failure: a call for standardized diagnostic criteria. Circulation 2000;101: 2118-21.
Remme WJ, Swedberg K. Guidelines for the diagnosis and treatment of chronic heart failure. Eur Heart J 2001;22: 1527-60.
Hunt SA, Baker DW, Chin MH, Cinquegrani MP, Feldman AM, Francis GS, et al. ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to revise the 1995 Guidelines for the Evaluation and Management of Heart Failure). J Am Coll Cardiol 2001;38: 2101-13.
The third criterion of the European Study Group on Diastolic Heart Failure (evidence of abnormal left ventricular relaxation, filling, diastolic distensibility, and diastolic stiffness) is important yet impractical in routine clinical practice.1 Vasan et al proposed that a more practical "probable" diagnosis of diastolic heart failure may be made in patients with clinical heart failure and normal or near normal systolic function but no objective evidence of diastolic dysfunction.2 Accordingly, I said that a probable diagnosis of diastolic heart failure can be made if echocardiography shows preserved systolic function. I also said that documentation of an abnormal left ventricular relaxation pattern would be required for a more specific diagnosis. I mentioned the ratio of early (E) to late or atrial (A) ventricular filling velocities along with its limitations as it is one of the most commonly used echocardiographic indices for diastolic dysfunction. Discussion of the comparatively new tissue Doppler imaging technique was beyond the scope of this brief review for generalist doctors.
I also agree with Walsh about the potential for B-type natriuretic peptide as a diagnostic tool. However, its use in diagnosing diastolic dysfunction is still evolving and is not recommended by major heart failure guidelines.3 4 In managing complex problems such as heart failure with rapidly evolving diagnostic and therapeutic strategies, generalist doctors might best follow specific guideline recommendations.
Ali Ahmed, assistant professor
Division of Gerontology and Geriatric Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA aahmed@uab.edu
References
European Study Group on Diastolic Heart Failure How to diagnose diastolic heart failure. Eur Heart J 1998;19: 990-1003.
Vasan RS, Levy D. Defining diastolic heart failure: a call for standardized diagnostic criteria. Circulation 2000;101: 2118-21.
Remme WJ, Swedberg K. Guidelines for the diagnosis and treatment of chronic heart failure. Eur Heart J 2001;22: 1527-60.
Hunt SA, Baker DW, Chin MH, Cinquegrani MP, Feldman AM, Francis GS, et al. ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to revise the 1995 Guidelines for the Evaluation and Management of Heart Failure). J Am Coll Cardiol 2001;38: 2101-13.