MECHANISMS OF DIASTOLIC HEART FAILURE IN AGING

描述：（来自应用）存在以下情况下的充血性心力衰竭 正常或接近正常的左心室收缩功能被称为 舒张性心力衰竭申请人认为， 至少50%的65岁以上患者因心力衰竭住院， 1995年（超过350，000名患者），患有原发性舒张性心力衰竭。 率 与舒张性心力衰竭相关的再住院和费用 与收缩性心力衰竭相当，但死亡率较低。 尽管它的流行，舒张功能衰竭的生理是差 最佳的诊断策略尚未确定， 治疗已显示出降低该疾病的死亡率。 本提案的研究阶段分为四个部分，将审查 容量状态、动脉僵硬度和心肌松弛在 老年人群舒张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 在舒张性心力衰竭和年龄 匹配的控制。 第2部分将确定动脉之间的关系 使用类似组的僵硬度和心肌松弛速度， 血管内压力的侵入性测量。 第三部分：高血压 年龄超过65岁的患者和年龄匹配的对照将使用非 脉动血流动力学和心肌舒张的有创测量 在第2部分验证。 血管扩张剂对这些测量的影响将是 测试以确定是否不同的药理作用， 动脉僵硬度对心肌舒张的影响不同。 使用 根据这三项研究的结果，将设计治疗方案 这将允许制定个性化的治疗计划， 每例舒张期心脏病患者的潜在生理异常 失败 治疗方案将针对充盈压、动脉压、 阻抗和反射动脉压力波的定时。 本议定书 然后将以随机方式与标准治疗进行比较， 确定该策略是否改善了再住院率，症状， 舒张期心脏病患者的生活质量和运动耐量 失败

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.