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Left Ventricular Diastolic Dysfunction

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Hypertension and Heart Failure

Part of the book series: Updates in Hypertension and Cardiovascular Protection ((UHCP))

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Abstract

Left ventricular (LV) diastolic dysfunction is a common condition in hypertensive patients, characterized by impaired relaxation and compliance of the LV, eventually leading to heart failure (HF). Chronic hypertension causes elevated LV end-diastolic pressure and LV hypertrophy, contributing to diastolic dysfunction. Neurohormonal activation and genetic factors also influence its onset. Diagnosis of diastolic dysfunction involves noninvasive and invasive approaches. Transthoracic echocardiography is commonly used, assessing factors like transmitral flow velocities, mitral annulus deformation, left atrial dimensions, and estimation of pulmonary artery pressures. Speckle-tracking echocardiography detects diastolic dysfunction early by evaluating strain and strain rate. Nuclear cardiology and cardiac magnetic resonance provide additional indices, but their clinical use is limited due to accessibility and processing time. Invasive evaluation through cardiac catheterization is the gold standard, allowing direct measurement of LV end-diastolic pressure and pulmonary capillary wedge pressure. Although noninvasive tests have extensively replaced invasive procedures in clinical practice, cardiac catheterization remains valuable in cases with inconclusive findings or when a differential diagnosis is required.

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Abbreviations

ATP:

Adenosine triphosphate

CMR:

Cardiac magnetic resonance

dPAP:

Diastolic pulmonary artery pressure

EDV:

End-diastolic volume

GLS:

Global longitudinal strain

HF:

Heart failure

HFpEF:

Heart failure with preserved ejection fraction

HFrEF:

Heart failure with preserved ejection fraction

HR:

Heart rate

IVRT:

Isovolumetric relaxation time

LA:

Left atrium

LAVi:

Left atrial volume index

LIFE:

Losartan intervention for end point reduction in hypertension

LV:

Left ventricle

LVEDP:

Left ventricular end-diastolic pressure

LVEF:

Left ventricular ejection fraction

LVH:

Left ventricular hypertrophy

mPAP:

Mean pulmonary artery pressure

PCWP:

Pulmonary capillary wedge pressure

PFR:

Peak filling rate

PV:

Pulmonary vein

SERCA:

Sarco/endoplasmic reticulum calcium ATPase

sPAP:

Systolic pulmonary artery pressure

SR:

Strain rate

STE:

Speckle-tracking echocardiography

TPFR:

Time to peak filling rate

TR:

Tricuspid regurgitation

TTE:

Transthoracic echocardiography

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Authors and Affiliations

  1. Health Science Interdisciplinary Research Center, Scuola Superiore Sant’Anna, Pisa, Italy

    Vincenzo Castiglione, Francesco Gentile, Alberto Aimo & Michele Emdin

  2. Fondazione Toscana Gabriele Monasterio, Pisa, Italy

    Vincenzo Castiglione, Francesco Gentile, Alberto Aimo & Michele Emdin

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  1. Vincenzo Castiglione
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  2. Francesco Gentile
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  3. Alberto Aimo
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  4. Michele Emdin
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Correspondence to Michele Emdin .

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Editors and Affiliations

  1. Carol Davila University of Medicine and Pharmacy, Bucharest, Bucuresti, Romania

    Maria Dorobantu

  2. Department of Pharmacology, Toxicology and Clinical Psychopharmacology Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania

    Victor Voicu

  3. University of Milano-Bicocca, Milano, Italy

    Guido Grassi

  4. Dept of Clinical and Experimental Sci, University of Brescia, Brescia, Italy

    Enrico Agabiti-Rosei

  5. University of Milano-Bicocca, Milano, Italy

    Giuseppe Mancia

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Castiglione, V., Gentile, F., Aimo, A., Emdin, M. (2023). Left Ventricular Diastolic Dysfunction. In: Dorobantu, M., Voicu, V., Grassi, G., Agabiti-Rosei, E., Mancia, G. (eds) Hypertension and Heart Failure. Updates in Hypertension and Cardiovascular Protection. Springer, Cham. https://doi.org/10.1007/978-3-031-39315-0_15

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