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ClinicalAspectsofDiastolicHeartFailureShin-ichiMomomura,MDCardiovascularCenterToranomonHospitalTokyo,Japan
IncidenceofHeartFailure
FraminghamHeartStudyJAmCollCardiol1993;22:6A–13AMaleFemale
DistributionofLeftVentricularEjectionFraction:EuroHeartFailureSurveyEuropeanHeartJournal(2003)24,442–463
WhatisDiastolicHeartFailure?Diastolic(Heart)FailureHeartfailureduetodiastolicdysfunctionHeartFailurewithPreservedorNormalSystolicFunctionCf)SystolicHeartFailure≒
CausesofDiastolicDysfunctionLeftventricularhypertrophy(common)AorticstenosisChronichypertensionHypertrophiccardiomyopathy(with/wothoutoutflowtractobstruction)Acuteepisodicmyocardialischemica(common)Pericardialdisease(rare)TamponadeConstrictionConstrictive-effusivediseaseduetopriorradiationtherapyRestrictivecardiomyopathy(rare)AmyloiddiseaseIdiopathicrestrictivecardiomyopathy
MechanismofDHFLVdiastolicdysfunction↓CONeurohormnalactivityExersionaldyspnea↓strokevolumeSodium/waterretension↑LVfillingpressureedemaPulmonaryedemaPulmonarycongestioncAcuteelevationofBP
EpidemiologyofDHF
PrevalenceofDHFDiagnosticCriteriaEvaluationofLVfunctionPrevalenceGhaliFHSFS24%(UCG)28%TaffetFHSEF45%(RNV)43%TakaradaFHSFS30%(UCG)24%VasanFHSEF50%(UCG)51%
Distributionoftheseverityofleftventricularsystolic
dysfunctionbyqualitativeassessmentWomenMenEuropeanHeartJournal(2003)24,442–463
PrognosisofDHFandSHF(1)EF＜50%EF≧50%7859584451354432362916151.00.80.60.40.001234560.2ExpectedEF＜50%EF≧50%SurvivalYearsSenniM.etal.：Circulation,98,2282,1998.P=0.279
PrognosisofDHFandSHF(2)SmithGL.JACC2003;41:1510-8
Characteristics:DemographicPreservedEF(n=200)DepressedEF(n=213)pValueAge73+1170+110.004Malegender74(37%)139(65%)0.001Whiterace158(79%)159(75%)0.30SmithGL.JACC2003;41:1510-8
Characteristics:CardiacHistoryPreservedEF(n=200)DepressedEF(n=213)pValueEF60+828+100.0001HF128(64%)169(79%)0.001Previous.hospi
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