Diastolische Herzinsuffizienz – Diagnosestellung und klinisches Vorgehen in der Praxis

Die diastolische Herzinsuffizienz ist ein häufiges Krankheitsbild, das für 50 % aller Patienten mit Herzinsuffizienz verantwortlich ist. Mortalität und Morbidität sind ähnlich wie bei der systolischen Herzinsuffizienz stark erhöht. Zur Diagnose ist vor allem eine Charakterisierung der diastolischen Dysfunktion erforderlich, wobei die Gewebedoppler-Technik in Kombination mit anderen Verfahren sowie der Messung des BNP wesentlich ist. Die Therapie dieser Patienten bleibt schwierig, da alle randomisierten Studien in diesem Krankheitsbild neutrale Ergebnisse brachten. Klinisch ist sicherlich eine strikte Behandlung der prädisponierenden Erkrankungen wie arterielle Hypertonie und Diabetes mellitus sinnvoll.

Diastolic heart failure is a frequently occurring clinical problem and is responsible for 50% of all patients with heart failure. Mortality and morbidity are strongly increased similar to those of systolic heart failure. For the diagnosis in particular a characterization of the diastolic dysfunction is necessary whereby the tissue Doppler technique in combination with other procedures as well as measurement of brain natriuretic peptide (BNP) play major roles. Therapy for these patients remains difficult since all randomized studies in this clinical entity have returned neutral results. From the clinical point of view a consequent treatment of predisposing diseases such as arterial hypertension and diabetes mellitus is certainly meaningful.

Key words

heart failure - diastolic dysfunction - diastolic heart failure

Literatur

• 1 Borlaug BA, Paulus WJ. Heart failure with preserved ejection fraction: pathophysiology, diagnosis, and treatment.  Eur Heart J. 2011;  32 670-679
• 2 Escher F, Westermann D, Gaub R et al.. Development of diastolic heart failure in a 6-year follow-up study in patients after acute myocarditis.  Heart. 2011;  97 709-714
• 3 Paulus WJ, Tschope C, Sanderson JE et al.. How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology.  Eur Heart J. 2007;  28 2539-2550
• 4 Wachter R, Schmidt-Schweda S, Westermann D et al.. Blunted frequency-dependent upregulation of cardiac output is related to impaired relaxation in diastolic heart failure.  Eur Heart J. 2009;  30 3027-3036
• 5 Borlaug BA, Nishimura RA, Sorajja P et al.. Exercise hemodynamics enhance diagnosis of early heart failure with preserved ejection fraction.  Circ Heart Fail. 2010;  3 588-595
• 6 Kasner M, Gaub R, Sinning D, Westermann D et al.. Global strain rate imaging for the estimation of diastolic function in HFNEF compared with pressure-volume loop analysis.  Eur J Echocardiogr. 2010;  11 743-751
• 7 Westermann D, Kasner M, Steendijk P et al.. Role of left ventricular stiffness in heart failure with normal ejection fraction.  Circulation. 2008;  117 2051-2060
• 8 Westermann D, Lindner D, Kasner M et al.. Cardiac Inflammation Contributes to Changes in the Extracellular Matrix in Patients with Heart Failure and Normal Ejection Fraction.  Circ Heart Fail. 2011;  4 44-52
• 9 Edelmann F, Schmidt AG, Gelbrich G et al.. Rationale and design of the ,aldosterone receptor blockade in diastolic heart failure' trial: a double-blind, randomized, placebo-controlled, parallel group study to determine the effects of spironolactone on exercise capacity and diastolic function in patients with symptomatic diastolic heart failure (Aldo-DHF).  Eur J Heart Fail. 2010;  12 874-882
• 10 Tschope C, Westermann D. Heart failure with normal ejection fraction. Pathophysiology, diagnosis, and treatment.  Herz. 2009;  34
• 11 Kamp O, Metra M, De GW Keulenaer et al.. Effect of the long-term administration of nebivolol on clinical symptoms, exercise capacity and left ventricular function in patients with heart failure and preserved left ventricular ejection fraction: background, aims and design of the ELANDD study.  Clin Res Cardiol. 2010;  99 75-82
• 12 Fukuta H, Sane DC, Brucks S, Little WC. Statin therapy may be associated with lower mortality in patients with diastolic heart failure: a preliminary report.  Circulation. 2005;  112
• 13 Pieske B. Heart failure with preserved ejection fraction – a growing epidemic or ,The Emperor's New Clothes?'.  Eur J Heart Fail. 2011;  13 11-13

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