HEART-FAILURE WITH NORMAL SYSTOLIC FUNCTION - A COMMON DISORDER IN OLDER-PEOPLE

OBJECTIVE: To review the incidence, pathophysiology, significance, dia gnosis, and treatment of heart failure with normal systolic function i n older patients. DATA SOURCE: Scientific reports of diastolic ventric ular dysfunction in both the general population and the geriatric popu lation were identified from repeated searches of the MEDLINE database and citations from appropriate articles. STUDY SELECTION: Studies were included only if they demonstrated proper methodology, were from a re putable source, and were published in a peer-reviewed journal. DATA EX TRACTION AND SYNTHESIS: Relevant data were obtained from the articles, with special importance placed on studies designed to examine older p atients exclusively or as part of a subgroup in a larger study. Emphas is was placed on data pertaining to the pathophysiology, prognosis, an d diagnosis of patients with diastolic dysfunction compared with norma ls and patients with systolic dysfunction as an etiology of heart fail ure. Therapeutic interventions were selected for the presence of prosp ective data with concrete end points such as mortality, functional cla ss, exercise capacity, and regression of left ventricular hypertrophy. CONCLUSION: Diastolic ventricular dysfunction is a significant proble m in older people, with at least 40% of older heart failure patients h aving diastolic dysfunction as the etiology of their heart failure. Th e pathophysiology of diastolic dysfunction is varied but usually invol ves impaired left ventricular relaxation and/or increased ventricular stiffness, each partially related to normal aging changes, as well as underlying cardiovascular diseases. The significance of heart failure caused by diastolic dysfunction is great, with increased morbidity and mortality compared with other cardiac diseases that have the same pre served systolic function. Diagnosis of diastolic dysfunction can be cl inically difficult and often requires further testing to determine if diastolic dysfunction is present. At this time, no therapy specificall y treats diastolic dysfunction, but several medications, such as diure tics, calcium channel blockers, beta blockers, and angiotension-conver ting enzyme inhibitors, offer symptomatic relief and may prevent progr ession of the disorder.