**Echocardiography in Heart Failure**

46 Echocardiography – In Specific Diseases

Vanninen, R., M. Aikia, et al. (1998). Subclinical cerebral complications after coronary artery

Whitley, W. S.&K. E. Glas (2008). An argument for routine ultrasound screening of the

Yamaguchi, A., H. Adachi, et al. (2009). Efficacy of intraoperative epiaortic ultrasound

Zamvar, V., D. Williams, et al. (2002). Assessment of neurocognitive impairment after off-

prospective randomised controlled trial. *Bmj* 325(7375): 1268.

52(9): 1179-1187.

12(4): 290-297.

*Neurol* 55(5): 618-627.

*Cardiovasc Surg* 15(2): 98-104.

ascending aorta in patients undergoing cardiac surgery. *Acta Anaesthesiol Scand*

bypass grafting: prospective analysis with magnetic resonance imaging, quantitative electroencephalography, and neuropsychological assessment. *Arch* 

thoracic aorta in the cardiac surgery population. *Semin Cardiothorac Vasc Anesth*

scanning for preventing stroke after coronary artery bypass surgery. *Ann Thorac* 

pump and on-pump techniques for coronary artery bypass graft surgery:

**4** 

*Japan* 

**Diastolic Heart Failure** 

*Osaka City University Graduate School of Medicine* 

Ryotaro Wake\*, Junichi Yoshikawa and Minoru Yoshiyama

The mortality, hospitalization, and prevalence rates of heart failure (HF) are increasing, in spite of decrease in coronary artery and cerebrovascular disease mortality.[1] Importantly, heart failure with normal ejection fraction (HFNEF) currently accounts for more than 50% of all heart failure patients and as the prevalence of HFNEF in the heart failure population

Approximately half of patients with a diagnosis of heart failure have a normal left ventricular (LV) ejection fraction (EF) without valve disease which is defined as diastolic heart failure (DHF), because it is attributed to LV diastolic dysfunction.[3] The prevalence of DHF increase even more dramatically with age more than HF with a reduced EF and is much more common in women than in men at any age. Studies examining prevalence of diastolic heart failure in hospitalized patients or in patients undergoing outpatient diagnostic screening and prospective community based studies have shown that the prevalence of diastolic heart failure approaches 50%.[4-6] Although HF patients with preserved systolic function has a slightly better prognosis than HF patients with abnormal systolic function, there is a fourfold higher mortality risk compared with subjects free of

Heart failure is a clinical syndrome characterized by symptoms and signs of increased tissue water and decreased tissue perfusion. Definition of the mechanisms that cause this clinical syndrome requires measurement of both systolic and diastolic function. When heart failure is accompanied by a predominant or isolated abnormality in diastolic function, this clinical syndrome is called diastolic heart failure. The pathophysiology is attributed to LV diastolic dysfunction, in which LV diastolic chamber size is normal or reduced despite elevated filling pressures resulting in decreased cardiac output. DHF occurs when the ventricular chamber is unable to accept an adequate volume of blood during diastole, because of a decrease in ventricular relaxation and/or an increase in ventricular stiffness,[3] and increased circulating blood volume is present. Hypertension, ischemia, aging and diabetes mellitus are the major risk factor of a decrease in ventricular relaxation and/or an increase in ventricular stiffness. Endocardial biopsies from HF patients without coronary artery

**1. Introduction** 

rises by 1% a year.[2]

**2. The mechanism of DHF** 

HF.[7]

 \*

Corresponding Author
