Heart Failure with Preserved Ejection Fraction (HFpEF) is becoming more common as the United States (U.S.A) population ages, along with the present of obesity pandemic. In general, HFpEF is the most common type of heart failure (HF) found in general population, however, the elderly, especially women are mostly suffering from it. It is primarily caused by obesity, hypertension, coronary artery disease, and diabetes. Obesity is frequent in individuals with HFpEF. However, it may constitute a distinct phenotype of HFpEF, with distinct hemodynamic and anatomical problems. Obesity causes a systemic inflammatory response which can lead to cardiac fibrosis and endothelial dysfunction. Because most obese patients are still excluded from HFpEF clinical trials, further research is needed to evaluate the role of pharmacologic and interventional treatments in this expanding group. Thus, this review study will aid in the understanding of HFpEF and its association with obesity.
Heart Failure, Diastolic

Heart Failure, Diastolic ; diagnosis ; prevention & control ; Humans

BACKGROUND AND OBJECTIVES: Diastolic heart failure (DHF) is defined as clinical evidences of heart failure, with a normal ejection fraction (EF) and abnormal diastolic function. However, the distinction between DHF and SHF is often difficult. Strain (S) and strain rate (SR) echocardiography can measure the regional myocardial function as a magnitude and rate of deformation. The hypothesis"myocardial velocity (Vel), S & SR can provide additional information for differentiation DHF from SHF"was assessed. SUBJECTS AND METHODS: 30 patients with symptomatic HF and low EF (SHF group) and 27 with symptomatic HF, and normal EF and diastolic dysfunction (DHF group) were enrolled. 37 age-and sex-matched control subjects were recruited. Conventional echo and regional indices (Vel, S and SR), measured at the mid septum and posterior wall, were obtained. RESULTS: Almost all clinical and echo indices of control were different between the two HF groups. The EF, LV mass, S' and DT in DHF were greater than those with SHF. The LA size, diastolic dysfunction grades; E, A, E/A, E', A' and E/E', were not different between the two HF groups. In the regional indices, the peak S (long axis: 12.0+/-5.4 vs. 17.6+/-5.9%, radial axis: 26.4+/-12.7 vs. 46.0+/-16.7%) and systolic Vel (long axis: 2.6+/-0.8 vs. 3.6+/-0.9 cm/s, radial axis: 2.1 (1.2 vs. 3.7+/-1.4 cm/s) with SHF were significantly lower than those with DHF. However, the SR of the two groups was not different. The best cutoff values of peak S were 13.7% (long axis) and 329% (radial axis), and the systolic Vel were 3.0 cm/s (long axis) and 2.8 cm/s (radial axis). CONCLUSION: The peak S and systolic Vel may be useful indices for differentiating DHF from SHF. A similarly decreased SR in the two HF groups suggests that DHF has decreased myocardial contractility, despite the normal EF.
Axis, Cervical Vertebra ; Echocardiography* ; Heart Failure ; Heart Failure, Diastolic* ; Humans

More than 50% of patients who are diagnosed with heart failure have preserved ejection fraction (HFpEF), and they have an equally poor prognosis when compared to patients with heart failure with reduced ejection fraction (HFrEF). However, a comprehensive understanding and awareness of heart failure with preserved ejection fraction is still limited and there are currently no optimized treatments to improve morbidity and mortality in these patients. This review summarizes the differences in the epidemiology, pathophysiology, diagnosis, and prognosis between HFpEF and HFrEF. We also review current management strategies of HFpEF patients according to evidence-based treatment guidelines.
Diagnosis ; Epidemiology ; Heart Failure* ; Heart Failure, Diastolic ; Humans ; Mortality ; Prognosis

BACKGROUND AND OBJECTIVES: There have been very few pathophysiologic studies on isolated diastolic dysfunction. We hypothesized that the characteristics of isolated diastolic dysfunction would be located, on the clinical continuum, between those of a normal heart and diastolic heart failure. SUBJECTS AND METHODS: We enrolled 102 subjects who had no history of overt symptoms of heart failure and who had a left ventricular ejection fraction of more than 50%. They were examined for myocardial deformation and rotation using the two-dimensional speckle tracking image (2D-STI) technique. RESULTS: The circumferential strains and radial strain at the apical level (RS(apex)) were related to the ratio of the transmitral early peak velocity over the early diastolic mitral annulus velocity (E/E'). After adjustment for age, the RS(apex) showed a positive relationship with the E/E' ratio; whereas, the circumferential strains did not. Instead, the circumferential strains demonstrated a significant correlation with age. Basal rotation and left ventricular (LV) torsion were also related to age, but had no relationship with the E/E' ratio. However, as the E/E' ratio value increased, systolic mitral annular velocity decreased. CONCLUSION: Except for the RS(apex), LV myocardial deformation and rotation did not vary with the degree of E/E' ratio elevation when there was no associated diastolic heart failure. Additionally, in clinical situations such as isolated diastolic dysfunction, the advancement of age has a relatively greater influence on characteristics of LV myocardial deformation and rotation rather than on the E/E' ratio.
Echocardiography, Doppler ; Heart ; Heart Failure ; Heart Failure, Diastolic ; Sprains and Strains ; Stroke Volume ; Track and Field

Mechanical dyssynchrony is a common phenomenon in patients with congestive heart failure, which usually identified by noninvasive cardiac imaging tools such as echocardiography. It demonstrates electromechanical delay in some regions of the failing heart which in turn contributes to further impairment of cardiac function. The diagnostic, therapeutic and prognostic values of mechanical dyssynchrony have been reported in a number of studies. Therefore, this review describes briefly the methods of measurement, but more importantly, explains the clinical implication of its assessment in heart failure related aspects including cardiac resynchronization therapy, functional mitral regurgitation, diastolic heart failure and mortality.
Cardiac Resynchronization Therapy ; Echocardiography ; Heart ; Heart Failure ; Heart Failure, Diastolic ; Humans ; Mitral Valve Insufficiency

BACKGROUND: The recent studies shows that LV relaxation abnormalities are the important factors of heart failure in elders. To determine the association between LV diastolic functions and heart failure, we assessed LV diastolic functions in elderly patients with pulmonary congestion and in asymptomatic elders by using pulsed doppler echocardiography. METHODS: In order to assess LV diastolic function, we performed pulsed doppler echocardiography to elderly patients with pulmonary congestion and asymptomatic elders from Mar.2001 to Sep.2001. The following parameters were used as indices of LV diastolic function; Mitral E wave(E), Mitral A wave(A), Deceleration time(DT), Isovolumic relaxation time(IVRT), Systolic pulmonary venous flow(PVs), Diastolic pulmonary venous flow(PVd). RESULTS: In elderly patients groups, there was significant increase in deceleration time compared with asymptomatic elders(255.83+/-54.41 vs 210.80+/-48.53, p<0.05). There was significant increase in isovolumic relaxation time in elderly patient group compared with asymptomatic elders(123.06+/-25.07 vs 98.78+/-15.12, p<0.01). Although there was no significant difference, decreased E/A ratio and increased PVs/PVd were noted in both groups. CONCLUSIONS: The results shows that the impairments of LV diastolic function were noted in both groups. Especially DT and JVRT were significant increase in elderly patient group with pulmonary congestion. Therefore these parameters, such as DT, IVRT, can be helpful as predictive indices of diastolic heart failure in elders.
Aged* ; Deceleration ; Echocardiography, Doppler, Pulsed ; Estrogens, Conjugated (USP)* ; Heart Failure ; Heart Failure, Diastolic ; Humans ; Relaxation

Heart failure with a normal ejection fraction is interchangeably termed diastolic heart failure. This condition is often unrecognized and it does have diagnostic, prognostic and therapeutic implications that are distinct from those conditions with systolic dysfunction. It is clinically important to understand and assess the diastolic function to reliably manage the patients suffering with heart failure. With the results of randomized trials for this distinct clinical syndrome, as well as the probability of better diagnostic testing in the future, physicians will in a better position not only to diagnose diastolic dysfunction or heart failure, but also to manage it more effectively. In this review, the physiology of the diastole and how to evaluate the abnormalities of the diastolic function will be discussed.
Diagnostic Tests, Routine ; Diastole ; Heart Failure ; Heart Failure, Diastolic ; Humans ; Physiology ; Ventricular Dysfunction, Left*

Constrictive pericarditis represents a rare cause of protein-losing enteropathy in children. Reported is an 11-year-old girl with protein-losing enteropathy (PLE) as the principal manifestations of constrictive pericarditis. After total pericardiectomy, symptoms and signs of PLE disappeared. Doppler echocardiography including tissue Doppler imaging is a useful noninvasive initial diagnostic tool for differential diagnosis of diastolic heart failure.
Child ; Diagnosis, Differential ; Echocardiography, Doppler ; Female ; Heart Failure, Diastolic ; Humans ; Pericardiectomy ; Pericarditis, Constrictive* ; Protein-Losing Enteropathies*

No abstract available.
*Echocardiography, Doppler ; Female ; Heart Failure, Diastolic/*mortality/*ultrasonography ; Humans ; Male ; Renal Insufficiency, Chronic/*mortality