From the Research
The treatment for grade III diastolic dysfunction should focus on managing heart failure symptoms and addressing the underlying cause, with a priority on reducing morbidity and mortality. The most recent and highest quality study, 1, published in 2023, highlights the importance of comprehensive assessment of diastolic function in patients with severe aortic stenosis and preserved left ventricular ejection fraction. Key treatment strategies include:
- Loop diuretics like furosemide (20-80mg daily) or torsemide (10-20mg daily) to reduce fluid overload and relieve symptoms
- ACE inhibitors (such as lisinopril 5-40mg daily) or ARBs (such as losartan 25-100mg daily) to reduce afterload and improve ventricular relaxation
- Beta-blockers like metoprolol succinate (25-200mg daily) or carvedilol (3.125-25mg twice daily) to control heart rate and improve diastolic filling time
- Aldosterone antagonists such as spironolactone (25-50mg daily) for additional diuresis and anti-fibrotic effects
- Lifestyle modifications, including sodium restriction (<2g daily) and fluid restriction (<2L daily) Regular monitoring of renal function, electrolytes, and blood pressure is essential when using these medications. The goal is to optimize preload, reduce afterload, control heart rate, and treat contributing conditions like hypertension, coronary artery disease, or atrial fibrillation. Grade III diastolic dysfunction represents a restrictive filling pattern with elevated left atrial pressures and is often associated with more advanced heart failure, making prompt and comprehensive treatment crucial, as supported by 1.