Diastolic Dysfunction: Association with Hypertension and Potential Target for Antihypertensive Therapy
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Diastolic Dysfunction: Association with Hypertension and Potential Target for Antihypertensive Therapy Kofo O. Ogunyankin
Published online: 30 April 2010 # Springer Science+Business Media, LLC 2010
Abstract The origins of diastole lie in the preceding systole. Echocardiographic evaluation for diastolic function in hypertension incorporates evaluation for morphologic changes such as left ventricular hypertrophy and functional changes, especially abnormalities in left ventricular relaxation and compliance. Investigational tools such as studies of cardiac mechanics are proving useful in elucidating the various stages of the adaptation of the heart to pressure load and for understanding the transition from asymptomatic diastolic dysfunction to heart failure with preserved left ventricular ejection fraction. The effects of treatment on cardiac morphology and function continue to generate controversy with regard to whether there is evidence for unique cardiac benefits of certain antihypertensive therapies beyond adequate blood pressure control. New insights into the treatment of co-morbidities that cluster with hypertension as strategies for controlling diastolic function, and pharmacologic therapies targeted toward myocardial fibrosis, have the potential to expand the options currently available for treating hypertensive heart disease. Keywords Diastolic dysfunction . Left ventricular relaxation . Left ventricular compliance . Hypertension
Introduction Diastolic dysfunction refers to the impairment of left ventricular (LV) relaxation and compliance, which is K. O. Ogunyankin (*) Division of Cardiology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair, Suite 600, Chicago, IL 60611, USA e-mail: [email protected]
usually asymptomatic [1] but may be may be associated with sudden onset congestive heart failure [2] with or without obvious abnormalities of contractile (systolic) function. Hypertension is the most common cause of cardiovascular disease worldwide and results in impairment of LV contractility, relaxation and compliance. Diastolic dysfunction in patients with hypertension is associated with increased morbidity and mortality [3]. Characterization of hypertension-related myocardial dysfunction has historically been limited by the diagnostic capabilities of the available tools for cardiac evaluation. Older literature focused on left ventricular hypertrophy (LVH) as a consequence of hypertension, and hence emphasized detection of abnormal LV mass and abnormal cavity morphology with increased relative wall thickness [4, 5]. The abnormalities of left ventricular relaxation and compliance were predominantly detected by cardiac catheterization [2, 3], and subsequently by traditional Doppler evaluation of mitral inflow and or pulmonary vein flow. Diastolic dysfunction is now defined in ways that link its genesis to specific abnormalities of contractile and relaxation function as well as compliance of the left ventricle. A comprehensive evaluation of diastolic function must now adequately
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