Cor Vasa 2004, 45(1):38-40
Diastolic heart failure and CHARM
- 1 II. interní klinika
- 2 I. interní-kardioangiologická klinika, Fakultní nemocnice u sv. Anny, Brno, Česká republika
Chronic heart failure occurs in 0.4-2% of the European population, with a prevalence of 1.3% reported for Eastern Europe; one out of three cases are diagnosed as diastolic dysfunction. Diastolic dysfunction is defined as a condition whereby there the ventricle is not filled enough, in the presence of normal left atrial pressure, to provide for adequate cardiac output. The main causes of diastolic dysfunction include coronary heart disease, hypertension, hypertrophic cardiomyopathy, heart valve disease with myocardial hypertrophy, restrictive myocardial disease, and constrictive pericarditis.
The goal of diastolic heart failure management is to improve the quality of life, i. e., to minimize or to eliminate altogether the symptoms, increase exercise tolerance, reduce mortality, and prolong the patient's life.
The priority in the management of diastolic heart failure is to treat the underlying disease, in particular hypertension (ACE inhibitors, beta-blockers, calcium channel blockers, diuretics) and coronary heart disease (revascularization, secondary prevention).
The first study of mortality with diastolic heart failure is CHARM-Preserved (Candesartan in Heart Failure - Assessment of Reduction in Mortality and Morbidity). The study included a total of 3,023 patients, with a mean follow-up of 36.6 months. The pre-defined primary end point of cardiovascular death and/or hospitalization reached borderline statistical significance, as did hospitalization for heart failure. A beneficial effect of candesartan on the prognosis of patients with heart failure and preserved ejection fraction was not demonstrated.
Keywords: Diastolic heart failure; Treatment; Prognosis; Candesartan
Published: January 1, 2004 Show citation