Lalande Sophie, Johnson Bruce D
Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
Drugs Today (Barc). 2008 Jul;44(7):503-13. doi: 10.1358/dot.2008.44.7.1221662.
Diastolic heart failure is characterized by the symptoms and signs of heart failure, a preserved ejection fraction and abnormal left ventricular (LV) diastolic function caused by a decreased LV compliance and relaxation. The signs and symptoms of diastolic heart failure are indistinguishable from those of heart failure related to systolic dysfunction; therefore, the diagnosis of diastolic heart failure is often one of exclusion. The majority of patients with heart failure and preserved ejection fraction have a history of hypertension. Hypertension induces a compensatory thickening of the ventricular wall in an attempt to normalize wall stress, which results in LV concentric hypertrophy, which in turn decreases LV compliance and LV diastolic filling. There is an abnormal accumulation of fibrillar collagen accompanying the hypertension-induced LV hypertrophy, which is also associated with decreased compliance and LV diastolic dysfunction. There are no specific guidelines for treating diastolic heart failure, but pharmacological treatment should be directed at normalizing blood pressure, promoting regression of LV hypertrophy, preventing tachycardia and treating symptoms of congestion. Preventive strategies directed toward an early and aggressive blood pressure control are likely to offer the greatest promise for reducing the incidence of diastolic heart failure.
舒张性心力衰竭的特征是具有心力衰竭的症状和体征、射血分数保留以及由左心室（LV）顺应性和舒张功能降低引起的左心室舒张功能异常。舒张性心力衰竭的症状和体征与收缩功能障碍相关的心力衰竭难以区分；因此，舒张性心力衰竭的诊断通常是排除性诊断之一。大多数射血分数保留的心力衰竭患者有高血压病史。高血压会导致心室壁代偿性增厚，试图使壁应力正常化，这会导致左心室向心性肥厚，进而降低左心室顺应性和左心室舒张期充盈。在高血压引起的左心室肥厚过程中，会出现纤维状胶原蛋白的异常积聚，这也与顺应性降低和左心室舒张功能障碍有关。目前尚无治疗舒张性心力衰竭的具体指南，但药物治疗应旨在使血压正常化、促进左心室肥厚消退、预防心动过速并治疗充血症状。早期积极控制血压的预防策略可能最有希望降低舒张性心力衰竭的发病率。
