MECHANISMS OF DIASTOLIC HEART FAILURE IN AGING

描述：(出自申请)充血性心力衰竭 正常或接近正常的左心室收缩功能称为 舒张性心力衰竭。根据申请人的说法，认为在 65岁以上的患者中至少有50%因心力衰竭住院 1995年(超过350,000名患者)，患有原发性舒张性心力衰竭。收费率 与舒张性心力衰竭相关的再住院和费用是 与收缩性心力衰竭相当，尽管死亡率更低。 尽管舒张性心衰很普遍，但其生理学方面的研究很差。 了解，最佳诊断策略尚未定义，并且没有 治疗已被证明可以降低这种疾病的死亡率。 这项建议的研究阶段分为四个部分，将审查 容量状态、动脉僵硬和心肌松弛在心肌梗死中的作用 老年人群中舒张期功能障碍的病理生理学。在第一部分中， 降低心内充盈压对心输出量的影响 在一组舒张性心力衰竭患者和年龄之间进行测量 配对的对照组。第2部分将确定动脉之间的关系 硬度和心肌松弛速度相似的组，使用 血管内压的侵入性测量。在第3部分，高血压 65岁以上的患者和年龄匹配的对照组将使用非 搏动性血流动力学和心肌松弛的有创测量 在第2部分中验证。血管扩张剂对这些测量的影响将是 测试以确定不同的药理作用是否对 动脉僵硬对心肌松弛有不同的影响。vbl.使用 根据这三项研究的结果，将设计一种治疗方案 这将允许开发个性化的治疗计划 每个舒张期心脏患者潜在的生理异常 失败了。治疗方案将针对充盈压力、动脉 阻抗和反射动脉压力波的时间。该协议 然后以随机方式与标准护理进行比较，以便 确定这一策略是否提高了再住院率、症状、 舒张期心脏患者的生活质量与运动耐量 失败了。

DESCRIPTION: (From application) Congestive heart failure in the presence of normal or near normal left ventricular systolic function is referred to as diastolic heart failure. According to the applicant, it is thought that at least 50% of patients older than 65 years hospitalized with heart failure in 1995 (over 350,000 patients), had primary diastolic heart failure. Rates of re-hospitalization and costs associated with diastolic heart failure are equivalent to those of systolic heart failure, although mortality is lower. Despite its prevalence, the physiology of diastolic failure is poorly understood, the optimal diagnostic strategy has yet to be defined, and no therapy has been shown to lower the mortality of the disease. The research phase of this proposal, which is in four parts, will examine the roles of volume status, arterial stiffness, and myocardial relaxation in the pathophysiology of diastolic dysfunction in an elderly population. In Part 1, the effects of lowering intracardiac filling pressures on cardiac output will be measured in a group of patients with diastolic heart failure and age matched controls. Part 2 will determine the relationship between arterial stiffness and myocardial relaxation velocity in a similar group, using invasive measurements of intravascular pressures. In Part 3, hypertensive patients over age 65 years and age-matched controls will be studied using non- invasive measurements of pulsatile hemodynamics and myocardial relaxation validated in Part 2. The impact of vasodilators on these measurements will be tested in order to determine whether disparate pharmacological effects on arterial stiffness lead to different effects on myocardial relaxation. Using the results of these three studies, a treatment protocol will be designed which will allow development of a therapeutic plan individualized to the underlying physiological abnormalities in each patient with diastolic heart failure. The treatment protocol will target filling pressures, arterial impedance, and timing of reflected arterial pressure waves. This protocol will then be compared with standard care in a randomized fashion, in order to determine whether this strategy improves re-hospitalization rate, symptoms, quality of life, and exercise tolerance in patients with diastolic heart failure.