Chinnaiyan Kavitha M, Alexander Daniel, Maddens Michael, McCullough Peter A
Division of Cardiology, William Beaumont Hospital, Royal Oak, MI 48073, USA.
Am Heart J. 2007 Feb;153(2):189-200. doi: 10.1016/j.ahj.2006.10.022.
Among the general heart failure (HF) population, over half have diastolic HF (DHF). The proportion of DHF increases with age, from 46% in patients younger than 45 years to 59% in patients older than 85 years. The diagnosis of DHF is made by the combination of signs and symptoms of HF with preserved systolic function (left ventricular ejection fraction >50%), and evidence of diastolic dysfunction obtained by echocardiographic Doppler examination, invasive hemodynamic evaluation, or an elevation of serum B-type natriuretic peptide. The most common risk factors for the development of diastolic dysfunction and DHF include long-standing hypertension, older age, female sex, obesity, diabetes, chronic kidney disease, and coronary artery disease. Acute decompensation occurs in the setting of pressure overload, volume overload, or superimposed cardiac ischemia. The cornerstones of in-hospital management include blood pressure and volume control, heart rate control, and correction of precipitating factors. Priorities in the outpatient clinic include optimal blood pressure control, maintenance of euvolemia with minimal or no diuretics, and, potentially, use of disease-modifying drugs including angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, aldosterone receptor blockers, beta-blockers, and digoxin. Long-term regression of left ventricular hypertrophy, improvement in diastolic filling parameters, and sustained reductions in B-type natriuretic peptide may be future treatment targets for this condition.
在一般心力衰竭（HF）人群中，超过半数患有舒张性心力衰竭（DHF）。DHF的比例随年龄增长而增加，从45岁以下患者中的46%升至85岁以上患者中的59%。DHF的诊断依据是HF的体征和症状与收缩功能保留（左心室射血分数>50%）相结合，以及通过超声心动图多普勒检查、有创血流动力学评估或血清B型利钠肽升高获得的舒张功能障碍证据。舒张功能障碍和DHF发生的最常见危险因素包括长期高血压、老年、女性、肥胖、糖尿病、慢性肾病和冠状动脉疾病。急性失代偿发生在压力负荷过重、容量负荷过重或叠加心脏缺血的情况下。住院管理的基石包括血压和容量控制、心率控制以及纠正诱发因素。门诊的重点包括优化血压控制、使用最少或不使用利尿剂维持血容量正常，以及可能使用改善病情的药物，包括血管紧张素转换酶抑制剂、血管紧张素II受体阻滞剂、醛固酮受体阻滞剂、β受体阻滞剂和地高辛。左心室肥厚长期消退、舒张期充盈参数改善以及B型利钠肽持续降低可能是这种疾病未来的治疗目标。
