Anguita Sánchez Manuel, Ojeda Pineda Soledad
Servicio de Cardiología. Hospital Universitario Reina Sofía, Córdoba, España.
Rev Esp Cardiol. 2004 Jun;57(6):570-5.
Diastolic heart failure (heart failure with preserved systolic function) causes 30% to 50% of all cases of heart failure, and its prognosis is almost as ominous as that of systolic heart failure. Currently, it is diagnosed when clinical criteria for heart failure are present and left ventricular ejection fraction is preserved (higher than 40% to 50%). However, determinations of brain natriuretic peptides may play an important role in the future. Because we have no evidence from clinical trials, with the exception of the slight benefit obtained with candesartan in reducing hospitalizations in the CHARM Study, treatment of diastolic heart failure is based on the identification and treatment of the causal factor (hypertension, coronary heart disease), control of heart rate, and relief of fluid congestion. Thus, combined therapy with low-dose diuretics, antihypertensive drugs for bradycardia (beta blockers, calcium antagonists) and angiotensin antagonists seems now to be the best therapeutic strategy.
舒张性心力衰竭（射血分数保留的心力衰竭）占所有心力衰竭病例的30%至50%，其预后几乎与收缩性心力衰竭一样凶险。目前，当存在心力衰竭的临床标准且左心室射血分数保留（高于40%至50%）时即可诊断。然而，脑钠肽的测定可能在未来发挥重要作用。由于除了坎地沙坦在CHARM研究中对减少住院有轻微益处外，我们没有来自临床试验的证据，舒张性心力衰竭的治疗基于对病因（高血压、冠心病）的识别和治疗、心率控制以及减轻液体潴留。因此，低剂量利尿剂、用于治疗心动过缓的抗高血压药物（β受体阻滞剂、钙拮抗剂）和血管紧张素拮抗剂的联合治疗目前似乎是最佳治疗策略。
