Current Opinion in Cardiology MAY 2009 by William J. McKenna, William T. Abraham, David Feldman

By William J. McKenna, William T. Abraham, David Feldman

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Treatment with a beta-blocker prevents tachycardia and thereby prolongs diastolic filling and reduces left atrial pressure [23,35]. Beta-blocker therapy Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. 1%). 051). 8%), another 16% for any cardiovascular cause; the remaining two out of three of hospitalizations are assumed to be noncardiovascular. The low heart failure event rates may reflect inadequate patient selection. Cross-sectional community-based studies systematically analyzing diastolic dysfunction with Doppler techniques and measuring LAV found that disease-specific mortality, heart failure hospitalization and symptom-limited heart failure were directly related to worsening diastolic dysfunction and increased LAV [4,40].

Circulation 2007; 116:637–647. 31 Bergstrom A, Andersson B, Edner M, et al. Effect of carvedilol on diastolic function in patients with diastolic heart failure and preserved systolic function. Results of the Swedish Doppler-echocardiographic study (SWEDIC). Eur J Heart Fail 2004; 6:453–461. 32 Zanchetti A, Cuspidi C, Comarella L, et al. Left ventricular diastolic dysfunction in elderly hypertensives: results of the APROS-diadys study. J Hypertens 2007; 25:2158–2167. 33 Abhayaratna WP, Marwick TH, Smith WT, Becker NG.

It may, therefore, be useful to consider the RV and pulmonary arteries together as a single, functional, interrelated unit [2]. The most recent classification of pulmonary hypertension centers on the underlying pathophysiologic process and response to therapy [7,8]. Table 1 outlines this current classification scheme. A detailed description of Category Examples PAH Idiopathic Familial Congenital systemic pulmonary shunts, connective tissue disease HIV Toxins Left-sided atrial or ventricular disease (LV systolic or diastolic dysfunction) Left-sided valvular heart disease Chronic obstructive lung disease Interstitial lung disease Sleep-disordered breathing Thromboembolic obstruction of pulmonary arteries Nonthrombotic obstruction of pulmonary arteries Sarcoidosis Histiocytosis X Pulmonary hypertension with left heart disease Pulmonary hypertension associated with lung disease/hypoxia Pulmonary hypertension due to chronic thrombotic or embolic disease or both Miscellaneous LV, left ventricular; PAH, pulmonary arterial hypertension.

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