Reinicke C
Geriatrische Klinik, Klinikum Bayreuth.
Z Gerontol Geriatr. 1996 May-Jun;29(3):210-5.
Age-related changes of diastolic left ventricular (LV) function consist of increased diastolic wall stiffness (reduced compliance) and diminished velocity and extent of relaxation. There is a shift of ventricular filling from early to late diastole. Atrial contribution to LV filling increases, which helps maintain stroke volume. In normal cardiovascular aging this diastolic dysfunction is compensated. However, the aging heart is sensitized against influences aggravating diastolic dysfunction such as arterial hypertension, LV hypertrophy, myocardial ischemia (coronary heart disease), tachycardias/ tachyarrhythmias. In diastolic heart failure LV is unable to fill adequately at normal diastolic pressures, resulting in symptoms of pulmonary congestion and, less often, low output despite normal LV size and contraction. Diastolic heart failure may be misinterpreted as systolic dysfunction and, eventually, treated in an unsuitable manner. In order to obtain data on the incidence of diastolic heart failure among inpatients of a department of geriatrics of a municipal hospital, the results of 253 patients undergoing echocardiography in the course of 1 year were analyzed. The investigations comprised 70 males and 183 females, aged 81.3 (61-98) years on average. In 164 cases, symptoms of heart failure were present. Only in 48 of them (29%) LV proved to be dilated. In the majority, LV size was normal (116 patients; 71%): systolic function was compromised in 53 cases, whereas 63 patients (38% of all cases with heart failure) had a normal systolic function. Most of the latter (48 patients) had diastolic dysfunction, whereas an adequate echocardiographic evaluation was not possible for technical reasons in the remaining 15 cases. It is highly probable, however, that they had diastolic LV dysfunction as well. Thus, the results show a high frequency of LV dysfunction in elderly inpatients, which underlines the importance of diastolic heart failure in this age group.
左心室舒张功能的年龄相关变化包括舒张期室壁僵硬度增加（顺应性降低）以及舒张速度和舒张程度减弱。心室充盈从舒张早期向晚期转移。心房对左心室充盈的贡献增加，这有助于维持心输出量。在正常的心血管衰老过程中，这种舒张功能障碍得到代偿。然而，衰老的心脏对加重舒张功能障碍的影响较为敏感，如动脉高血压、左心室肥厚、心肌缺血（冠心病）、心动过速/快速心律失常。在舒张性心力衰竭中，左心室在正常舒张压力下无法充分充盈，导致肺淤血症状，较少见的是尽管左心室大小和收缩正常但心输出量降低。舒张性心力衰竭可能被误诊为收缩功能障碍，并最终得到不恰当的治疗。为了获取市立医院老年病科住院患者中舒张性心力衰竭的发病率数据，对253例在1年期间接受超声心动图检查的患者结果进行了分析。调查对象包括70名男性和183名女性，平均年龄81.3（61 - 98）岁。164例患者存在心力衰竭症状。其中只有48例（29%）左心室被证实扩大。大多数情况下，左心室大小正常（116例患者；71%）：53例患者收缩功能受损，而63例患者（占所有心力衰竭病例的38%）收缩功能正常。后者中的大多数（48例患者）存在舒张功能障碍，而其余15例因技术原因无法进行充分的超声心动图评估。然而，很可能他们也存在左心室舒张功能障碍。因此，结果显示老年住院患者左心室功能障碍的发生率很高，这突出了舒张性心力衰竭在该年龄组中的重要性。
