M. JESSUPM. JESSUP

Tenth International Symposium

HEART FAILURE & Co.CARDIOLOGY SCIENCE UPDATE FEMALE DOCTORS SPEAKING

ON FEMALE DISEASES

Milano9 - 10 aprile 2010

Heart Failure in Women

Diastolic Heart Failure: a Matter of Not Compliant

Myocardium

Mariell Jessup MD, FAHA, FACC

Professor of Medicine

University of Pennsylvania

Fonarow et al. JACC 2007; 50:768Fonarow et al. JACC 2007; 50:768 OPTIMIZE-HFOPTIMIZE-HF

312 patients, mean age:66 years, LVEF: 50%, 34% women.

The median follow-up was 18.7 months.

Diastolic dysfunction: 67% of classified patients moderate and severe DD: 44%

312 patients, mean age:66 years, LVEF: 50%, 34% women.

The median follow-up was 18.7 months.

Diastolic dysfunction: 67% of classified patients moderate and severe DD: 44%

JACC 2007; 49: 687JACC 2007; 49: 687

CHARMCHARM

Serum markers of fibrosis (CITP and PIIINP) are associated with systolic and diastolic HF in community-dwelling elderly

individuals.

These associations remained significant even after adjustment for demographic and clinical characteristics,

bone mineral density and NT-proBNP.

Serum markers of fibrosis (CITP and PIIINP) are associated with systolic and diastolic HF in community-dwelling elderly

individuals.

These associations remained significant even after adjustment for demographic and clinical characteristics,

bone mineral density and NT-proBNP.

Stress does not commonly induce systolic dysfunction in patients with HFNEF.

It is unlikely that exercise intolerance is due to global regional or long-axis systolic dysfunction or other non-cardiac causes.

Abnormalities in diastolic function are often induced or exacerbated by stress in these patients,

Stress-induced impairment of early diastolic relaxation with consequent rise in the LV end-diastolic pressure is the likely cause of exercise intolerance.

Diastolic Heart Failure: a Matter of Not Compliant Myocardium

• Women age their hearts differently than men, setting the stage for less compliant myocardium.

• Heart rate response is also not normal in HFpEF.

• The abnormal myocardium is not just more fibrotic.

• Other aging factors and multiple co-morbidities must play a role.