Risk Factors for Diastolic Dysfunction
The primary risk factors for diastolic dysfunction include advanced age, female gender, hypertension, left ventricular hypertrophy, coronary artery disease, diabetes mellitus, and obesity. 1, 2
Risk Factor Profile
Major Risk Factors
- Age: Particularly prevalent in elderly patients 1, 2
- Gender: Higher prevalence in women 3
- Hypertension: Leading cause of left ventricular hypertrophy 2, 3
- Left ventricular hypertrophy: Common structural change leading to impaired relaxation 2, 4
- Coronary artery disease: Causes myocardial ischemia affecting relaxation 1, 3
- Diabetes mellitus: Associated with microvascular disease and myocardial fibrosis 3
- Obesity: Increases cardiac workload and promotes hypertrophy 3
Additional Risk Factors
- Valvular heart disease (particularly aortic stenosis) 4
- Hypertrophic or restrictive cardiomyopathy 2
- Tachycardia (reduces diastolic filling time) 2
- Renal dysfunction 5
- Increased body mass index 3
Pathophysiological Mechanisms
Diastolic dysfunction develops through several mechanisms:
- Delayed relaxation of the left ventricle
- Impaired left ventricular filling
- Increased myocardial stiffness
- Increased fibrosis of the myocardium
- Myocardial scarring or infiltrative processes
These changes lead to elevated diastolic filling pressures and symptoms of heart failure despite preserved ejection fraction 1, 2.
Management Strategies
Blood Pressure Control
- Target blood pressure <140/90 mmHg for most patients
- Target <150/90 mmHg for patients over 60 years old 1
- ACE inhibitors/ARBs are preferred, especially with hypertension, diabetes, or chronic kidney disease 1
Heart Rate Control
- Beta-blockers to reduce heart rate and increase diastolic filling time
- Particularly useful in patients with tachycardia, ischemia, or hypertension 1
Volume Management
- Diuretics to reduce central blood volume and pulmonary congestion
- Sodium restriction, especially in advanced heart failure 1
- Careful use of diuretics to avoid hypotension and low output states 3
Myocardial Ischemia Treatment
- Coronary revascularization when ischemia negatively affects diastolic function
- Particularly important when symptomatic or demonstrable myocardial ischemia is present 1, 6
Additional Pharmacological Approaches
- Calcium channel blockers (especially non-dihydropyridines like verapamil) to increase diastolic filling time 1
- Aldosterone antagonists (spironolactone 12.5-25 mg daily) for severe diastolic dysfunction 1
- Nitrates for symptom relief by reducing preload and pulmonary congestion 1
Medications to Avoid
- NSAIDs and COX-2 inhibitors
- Class I antiarrhythmic agents
- Tricyclic antidepressants
- Corticosteroids 1
Monitoring and Follow-up
- Regular evaluation of symptoms and treatment efficacy
- Monitoring for medication side effects
- Assessment of volume status to guide diuretic therapy
- Surveillance for progression to systolic dysfunction 1
Prognosis
The prognosis for diastolic dysfunction is generally better than for systolic heart failure, with an annual mortality rate of approximately 8% compared to 19% for systolic heart failure. However, morbidity rates can be substantial, particularly in elderly patients 1, 2.