Heart failure (HF) is a major public health problem. Clinical studies suggest that a significant proportion of patients with HF have preserved ejection fraction, a clinical syndrome commonly referred to as diastolic HF (DHF). One of the purposes of epidemiological studies is to identify unmet public health needs in a population and to quantify the magnitude of the problem in a manner that is free from the referral bias inherent in clinical studies. We review current epidemiological data estimating the prevalence of DHF, highlight the challenges posed by existing data, and suggest focus for future studies on the epidemiology of DHF. We limited the review to studies that met our definition of population-based studies (eg, studies drawing participants from a defined community or all consecutive referrals to a health facility that is the sole provider to a defined community). Studies relevant to the epidemiology of each stage of DHF (American College of Cardiology/American Heart Association stages A-D) were reviewed. These epidemiological studies clearly define the magnitude of this health care problem and underscore the urgent need for studies elucidating the natural history, pathophysiology, and optimal diagnostic and management strategy for this extremely common clinical syndrome.
"However, in the branch hospitals without attending cardiologists, left ventricular ejection fraction was occasionally missing (≈ 10% in the incidence cohort; Table 1). Patients with a left ventricular ejection fraction of 50% or higher were classified as having HF preserved-EF, whereas those with an ejection fraction of less than 50% were classified as HF reduced-EF  . "
[Show abstract][Hide abstract] ABSTRACT: Sex specific temporal trends in the incidence and prevalence of hospitalization for heart failure (HF), particularly in conjunction with reduced and preserved left ventricular ejection fraction (EF) remain unclear, especially in Asian general populations.
"While TDI velocities (s’ e’ a’) are age dependent in a large cohort of healthy (non marathon runners) volunteers . Furthermore it is known that diastolic left ventricular dysfunction has a higher prevalence in elderly and it leads to age-related normal values of mitral inflow velocities and time intervals [15,16]. In contrast to this observation a small study described that left ventricular compliance can be preserved in elderly by regular endurance training . "
[Show abstract][Hide abstract] ABSTRACT: Regular physical activity reduces cardiovascular risk. There is concern that Marathon running might acutely damage the heart. It is unknown to what extent intensive physical endurance activity influences the cardiac mechanics at resting condition.
Eighty-four amateur marathon runners (43 women and 41 men) from Berlin-Brandenburg area who had completed at least one marathon previously underwent clinical examination and echocardiography at least 10 days before the Berlin Marathon at rest. Standard transthoracic echocardiography and 2D strain and strain rate analysis were performed. The 2D Strain and strain rate values were compared to previous published data of healthy untrained individuals.
The average global longitudinal peak systolic strain of the left ventricle was -23 +/- 2% with peak systolic strain rate -1.39 +/- 0.21/s, early diastolic strain rate 2.0 +/- 0.40/s and late diastolic strain rate 1.21 +/- 0.31/s. These values are significantly higher compared to the previous published values of normal age-adjusted individuals. In addition, no age-related decline of longitudinal contractility in well-trained athletes was observed.
There is increased overall longitudinal myocardial contractility at rest in experienced endurance athletes compared to the published normal values in the literature indicating a preserved and even supra-normal contractility in the athletes. There is no age dependent decline of the longitudinal 2D Strain values. This underlines the beneficial effects of regular physical exercise even in advanced age.
"First, the overall event rate was low, with 3-year mortality being 10.2 %. This is in sharp contrast with the previously reported annual mortality rates of 22–29% in large community-based studies.14,15 This concern is further intensified by a primary event rate (in the placebo group) of 8.4% in Russia and the Republic of Georgia: a rate which not only is unheard of in heart failure studies, but also one that is remarkably less than that observed in the “American” arm of the same study (31.8%). "
[Show abstract][Hide abstract] ABSTRACT: Heart failure with preserved ejection fraction (HFpEF) continues to be a challenging form of heart failure - one in which no therapy has yet been proven to improve outcome. Aldosterone antagonists have previously been shown to improve survival in a wide spectrum of patients with heart failure with reduced ejection fraction (HFrEF), and more recently, small trials suggested that they might have role in HFpEF patients. The effect of spironolactone on clinical outcomes in HFpEF was tested in the TOPCAT study.
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