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Diastology
Clinical Approach to Heart Failure with Preserved Ejection Fraction
- 2nd Edition - November 18, 2020
- Authors: Allan L. Klein, Mario J. Garcia
- Language: English
- Hardback ISBN:9 7 8 - 0 - 3 2 3 - 6 4 0 6 7 - 1
Accounting for more than 40% of all heart failure problems, diastolic heart failure is a complex and often difficult diagnosis with rapidly evolving diagnostic management pr… Read more
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Request a sales quoteAccounting for more than 40% of all heart failure problems, diastolic heart failure is a complex and often difficult diagnosis with rapidly evolving diagnostic management protocols. Diastology: Clinical Approach to Heart Failure with Preserved Ejection Fraction, 2nd Edition, brings you up to date and equips you to successfully diagnose and manage even the most challenging incidences of diastolic heart failure and their comorbidities. It incorporates the latest guidelines for the diagnostic evaluation of the patient with suspected or known diastolic dysfunction, provides a comprehensive review of clinical conditions associated with heart failure with preserved ejection fraction, and describes the complementary role of imaging modalities and novel therapeutic approaches.
- Keeps you current with recent extensive changes in the understanding of the mechanisms of diastolic heart failure with preserved ejection fraction (HFpEF) that have resulted in dramatic changes in treatment guidelines.
- Covers the latest molecular, genetic, and cellular mechanisms behind diastolic heart failure as a basis for the latest clinical approaches, diagnosis, and treatment of common and uncommon pathological conditions such as hypertensive heart disease, cardiomyopathies, arterial and valvular diseases, pericardial diseases, congenital heart disease, diabetes mellitus, and metabolic syndrome.
- Features 50 video cases, new key summary points, new multiple-choice review questions, and six new chapters: Evaluation of Diastolic Function by Radionuclide Techniques; Diastology Stress Test; ASE/EACVI Diastolic Guidelines; Valve Disease; Perioperative Assessment of Diastolic Dysfunction; and Pulmonary Hypertension.
- Reviews new techniques and indices for assessing diastolic function, such as 3D echo, strain rate imaging, late gadolinium enhancement and T1-mapping by CMR, and novel nuclear scintigraphic methods – as well as the traditional indices of LV filling, LA function, and tissue Doppler indices.
- Covers emerging topics such as the role of neurohormones, global and regional systolic function of the left ventricle, chronotopic incompetence and pacing, aging, perioperative assessment, and more.
- Presents information in a quick-retrieval format, covering Epidemiology, Pathophysiology, Diagnostic Evaluation, Differential Diagnosis, Treatment, and Future Directions.
- Helps you learn efficiently and prepare for self-assessment with key summaries and multiple-choice questions and answers for each chapter.
- Enhanced eBook version included with purchase. Your enhanced eBook allows you to access all of the text, figures, and references from the book on a variety of devices.
- Cover
- Title page
- Contents
- Copyright
- List of Contributors
- Foreword
- Foreword
- Preface
- Acknowledgments
- Video Table of Contents
- Part I: Basic Determinants of Diastolic Function
- 1: Molecular, Gene, and Cellular Mechanism
- Abstract
- Myocyte Stiffness
- Myocardial Collagen
- Future Directions
- 2: Pathophysiology of Heart Failure With a Preserved Ejection Fraction: Measurements and Mechanisms Causing Abnormal Diastolic Function
- Abstract
- Introduction
- Normal Diastolic Function
- Measurements of LV Relaxation and Filling
- Pathophysiologic Determinants of LV Relaxation and Filling
- Measurement of LV Diastolic Stiffness, Compliance, Distensibility, and Pressure
- Pathophysiologic Determinants of Diastolic Stiffness
- Abnormal Diastolic Function Limits Exercise in HFpEF
- Abnormal Diastolic Function Causes Acute Decompensated HFpEF
- Prevalence of Diastolic Dysfunction in HFpEF
- Prognostic Value of Abnormal Diastolic Function in HFpEF
- Future Directions
- 3: Role of the Pericardium in Diastolic Dysfunction
- Abstract
- Introduction
- Anatomy and Physiology of the Pericardium
- Noninvasive Imaging of the Pericardium
- Pathophysiology of Pericardial Syndromes Affecting Diastolic Function
- Future Directions
- 4: Left Atrial Function: Basic Physiology
- Abstract
- Introduction
- Anatomic and Histologic Considerations
- Pathophysiology
- Left Atrial Function in Disease
- Future Directions
- Acknowledgments
- 5: Physical Determinants of Diastolic Flow
- Abstract
- Pathophysiology
- Clinical Relevance
- Future Directions
- 6: Ventricular–Arterial Interaction in Patients With Heart Failure and a Preserved Ejection Fraction
- Abstract
- Introduction
- Pathophysiology of Left Ventricular-Arterial Coupling
- Clinical Relevance: Therapeutic Strategies Targeting Stiffness
- Future Directions
- Part II: Diagnosis of Heart Failure With Preserved Ejection Fraction
- 7: General Principles, Clinical Definition, Epidemiology, and Pathophysiology
- Abstract
- Introduction
- Comorbid Conditions
- Future Directions
- 8: Invasive Hemodynamic Assessment in Heart Failure With Preserved Ejection Fraction
- Abstract
- Introduction
- Invasive Assessment of Systolic Function
- Invasive Assessment of Diastolic Function
- The pathophysiology of HFpEF
- Diagnosis of HFpEF
- Beyond the Left Heart
- Future Directions
- 9: Two-Dimensional and Doppler Evaluation of Left Ventricular Filling, Including Pulmonary Venous Flow Velocity
- Abstract
- Abbreviations
- Introduction
- Left ventricular Filling: A Historical Perspective
- Left Ventricular Filling
- Pulmonary Venous Flow Velocity
- Ancillary Data That Helps the Interpretation of Mitral Flow Velocity Patterns
- Performing an Echo Doppler Evaluation of LV Diastolic Function
- Mitral Flow Velocity Patterns: Interpretive Challenges
- Right Ventricular Diastolic Function
- Using LV Filling Patterns for Patient Management
- Limitations
- Future Directions
- Echo Variables
- Echo Variables
- Echo Variables
- Echo Variables
- 10: Evaluation of Diastolic Function by Tissue Doppler, Strain, and Torsion Analysis
- Abstract
- Introduction
- Technical Considerations
- Normal Physiology
- Abnormal Myocardial Deformation in HFpEF
- Clinical Utility of Deformation Indices
- Future Directions
- 11: Color M-mode Doppler
- Abstract
- Introduction
- Background
- CMM Doppler and Diastolic Function
- Clinical Relevance
- Vector Flow Mapping
- Future Directions
- 12: Assessment of Left Atrial Size and Function
- Abstract
- Introduction
- Measurement of Left Atrial Size
- Assessment of Left Atrial Function
- Risk Stratification and Prognostic Prediction With Left Atrial Size and Function
- Future Directions
- 13: Evaluation of Intracardiac Filling Pressures
- Abstract
- Definition of Filling Pressures
- Mechanisms of Diastolic Pressure Elevation
- Evaluating LV Relaxation
- Estimating Filling Pressures in Sinus Rhythm
- Evaluation in Challenging Cases
- Newer Developments
- Preparing a Clinically Meaningful Report
- Future Directions
- 14: Evaluation of Right Ventricular Diastolic Function
- Abstract
- Introduction
- Invasive Assessment of RV Diastolic Function
- Right Atrial Size
- Right Atrial Function
- RV Morphology: size and wall thickness
- RV Systolic Function Parameters
- Noninvasive Estimation of Mean Right Atrial Pressure
- Future Directions
- 15: Evaluation of Diastolic Function by Cardiac Magnetic Resonance Imaging
- Abstract
- Introduction
- Physics of MRI
- Basic Imaging Sequences
- Phase Velocity or Phase Contrast Imaging
- Myocardial Strain
- Magnetic Resonance Spectroscopy
- Late Gadolinium Enhancement
- Quantitative T1 Mapping and Extracellular Volume Measurements
- Diffusion Tensor Imaging
- MR Elastography
- Four-Dimensional Flow
- Clinical Correlation
- LV Mass
- Hypertrophic Cardiomyopathy
- Limitations and Contraindications of Cardiac MRI
- Future Directions
- 16: Evaluation of Diastolic Function by Radionuclide Techniques
- Abstract
- Introduction
- Basic Principles of Radionuclide Assessment of Diastolic Function
- Data Acquisition and Analysis of Diastolic Function by Radionuclide Techniques
- Clinical Relevance
- Limitations
- Future Directions
- 17: Diastolic Echocardiographic Examination
- Abstract
- Introduction
- Key Echocardiographic Parameters
- Complementary Echocardiographic Parameters
- Acquisition and Measurement of Key Echocardiographic Variables
- Acquisition and Measurement of Complementary Echocardiographic Parameters
- Respiratory Monitoring and Special Maneuvers
- Diastolic Stress Testing
- Right Ventricular Diastolic Function
- Future Directions
- 18: Diastology Stress Test
- Abstract
- Epidemiology
- Pathophysiology
- Diagnostic Evaluation
- Future Directions
- 19: ASE/EACVI Diastolic Guidelines: Strength and Limitations
- Abstract
- Definition and Grading of Diastolic Dysfunction
- Diagnosing HFpEF and Estimation of LV Filling Pressure
- Additional Parameters to Be Used in the Evaluation of Diastolic Function
- Evaluation of Diastolic Function in Special Populations
- Atrial Fibrillation
- Mitral Annular Calcification
- Heart Transplants
- Future Directions
- Part III: Cardiac Diseases With HFpEF
- 20: Hypertension and Its Relation to Heart Failure With a Preserved Ejection Fraction
- Abstract
- Introduction
- Epidemiology of Hypertension in HFpEF
- Pathophysiology of Diastolic Dysfunction in HyperTeNsion and HFpEF
- Diagnostic Evaluation of Patients with Hypertension and HFpEF
- Hypertension Treatment: Current Status in relation to HFpEF
- Future Directions
- 21: Valve Disease
- Abstract
- Introduction
- Epidemiology of Valvular Heart Disease
- Aortic Stenosis
- Aortic Regurgitation
- Mitral Regurgitation
- Mitral Annular Calcification
- Mitral Stenosis
- Prosthetic Valves
- Treatment
- Future Directions
- 22: Stage D Heart Failure With Preserved Ejection Fraction, Heart Transplantation, and Mechanical Circulatory Support
- Abstract
- Definition of Stage D Heart Failure
- HFpEF Phenotypes Resulting in Stage D HF
- Epidemiology
- Implantable Hemodynamic Monitoring in HFpEF
- Interatrial Shunt Devices in Treatment of HFpEF
- Pharmacologic Management of Acute and Chronic Stage D HFpEF
- Durable Mechanical Circulatory Support in Patients With Stage D HFpEF
- Heart Transplantation for Stage D HFpEF: Trends and National Outcomes
- Physiology of the Transplanted Heart
- Diastolic Function After Heart Transplant
- Diastolic Function in Allograft Rejection
- Future Directions
- 23: Primary Restrictive, Infiltrative, and Storage Cardiomyopathies
- Abstract
- Introduction
- Pathophysiology
- Clinical Relevance
- Future Directions
- 24: Coronary Artery Disease
- Abstract
- Introduction
- Pathophysiology
- Clinical Relevance
- Future Directions
- 25: Hypertrophic Cardiomyopathy
- Abstract
- Diastolic Function in Hypertrophic Cardiomyopathy
- Pathophysiology of Diastolic Dysfunction
- Clinical Presentation and Prognosis
- Diagnosis of Diastolic Dysfunction in HCM
- Conventional Two-Dimensional (2-D) Transthoracic Echocardiography
- Algorithm for Diastolic Function Assessment on Conventional Echocardiography
- Emerging Methods for the Assessment of Diastolic Function in HCM
- Differential Diagnoses
- Treatment of HCM and Effects on Diastolic Function
- Invasive Septal Reduction Therapies
- Future Directions
- 26: Pericardial Diseases: Constrictive Pericarditis and Pericardial Effusion
- Abstract
- Epidemiology
- Pathophysiology
- Diagnostic Evaluation
- Differential Diagnosis
- Treatment
- Future Directions
- 27: Diastolic Function in Children and in Children With Congenital Heart Disease
- Abstract
- Introduction
- Normal Diastolic Function in Children and Developmental Aspects
- Pathophysiology of Diastolic Dysfunction in Children With Congenital Heart Disease
- Difficulties in Assessing Diastolic Function in Children and Applicability of Adult Guidelines
- Echocardiographic Evaluation of Diastolic Function in Children
- Diastolic Dysfunction in Specific Congenital Heart Disease
- Cardiomyopathies
- Diastolic Function in Conditions Predominantly Affecting the Right Ventricle
- Diastolic Assessment in the Functionally Single Ventricle
- Future Directions
- 28: Diabetes Mellitus
- Abstract
- Introduction
- Mechanisms and Predictive Factors of Diabetic Cardiomyopathy
- Insulin Resistance and Altered Insulin Signaling in Diabetes
- Metabolic Factors
- Altered Coronary Microcirculation
- Myocardial Fibrosis
- Inappropriate Activation of Neurohormones
- Interaction With Hypertension and Coronary Artery Disease
- Cardiac Imaging in Patients With Diabetes
- Management
- Future Directions
- Conclusion
- Part IV: Emerging Topics in HFpEF
- 29: Global and Regional Systolic Function of the Left Ventricle
- Abstract
- Introduction
- Historical Views of EF as an Indicator of LV Function
- Current Controversies on EF as the Fundamental Determinant of HF
- Normal Physiology: Mechanisms Showing How Systole and Diastole Talk to Each Other
- Invasive Hemodynamic Assessment
- Echocardiographic Assessment
- Myocardial Performance (Tei) Index
- Tissue Doppler Systolic Velocities
- Myocardial Strain and Torsion
- Systolic Dysfunction in HF With Preserved EF
- Future Directions
- Acknowledgments
- 30: Chronotropic Incompetence and Pacing in HPEF Heart Failure with Preserved Ejection Fraction
- Abstract
- Introduction
- Basic Function of Permanent Cardiac Pacemakers
- Diastolic Dysfunction
- Chronotropic Incompetence in Diastolic Heart Failure
- Pathophysiology
- Adverse Effects of Pacing on Cardiac Function
- Diagnostic Evaluation and Optimization of Dyssynchrony
- Future Directions
- 31: Aging and Heart Failure With Preserved Ejection Fraction
- Abstract
- Introduction
- HFpEF and the Elderly
- Cardiovascular Aging, Diastolic Dysfunction, and HFpEF
- Future Directions
- Conclusions
- 32: Perioperative Assessment of Diastolic Function
- Abstract
- Introduction
- Current Guidelines for Diastolic Assessment
- The Effect of the Perioperative Period on the Assessment of LV Diastolic Dysfunction
- Disease-Specific Assessment of Diastolic Dysfunction
- Echocardiographic Predictors of Surgical Outcome
- Diastolic Assessment in the Postoperative Cardiac Surgery Patient
- How to Approach Diastolic Assessment in the Perioperative Period
- Conclusions
- Future Directions
- 33: Pulmonary Hypertension in Heart Failure With Preserved Ejection Fraction
- Abstract
- Abbreviations
- Definition and Classification of PH
- Future Directions
- Part V: Treatment of HFpEF
- 34: General Treatment of Heart Failure With Preserved Ejection Fraction and Randomized Trials
- Abstract
- Introduction
- Background
- Pathophysiology
- General Treatment Guidelines
- Treatment of Comorbidities
- Specific Therapies
- Key Ongoing Phase III RCTs
- Case Study Conclusion
- Future Directions
- 35: Echo-Based Approach to the Management of Heart Failure With Preserved Ejection Fraction
- Abstract
- Introduction
- Pathophysiology
- Clinical Relevance
- Summary
- Future Directions
- 36: Future Therapies in HFpEF
- Abstract
- Introduction
- Pathophysiology and Clinical Relevance
- Future Directions
- Part VI: Cases of Diastolic Heart Failure
- 37: Cases of Diastolic Heart Failure
- Case 1
- Case 2
- Case 3
- Case 4
- Case 5
- Case 6
- Case 7
- Case 8
- Case 9
- Case 10
- Answers
- Review Question Answers
- Index
- No. of pages: 544
- Language: English
- Edition: 2
- Published: November 18, 2020
- Imprint: Elsevier
- Hardback ISBN: 9780323640671
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Allan L. Klein
Affiliations and expertise
Department of Cardiovascular Medicine, The Cleveland Clinic, Cleveland, OHMG
Mario J. Garcia
Dr. Mario J. Garcia is an eminent cardiologist and leader in the development and clinical implementation of the most advanced noninvasive cardiac diagnostic technology used around the world today. A physician, researcher and educator, he is known worldwide for his innovative use of noninvasive cardiac imaging in the clinic, such as coronary CT angiography (including some of the earliest studies testing radiation-reduction strategies), echocardiography, and MRI. Dr. Garcia joined Einstein/Montefiore as Chief of the Division of Cardiology in 2010. He holds the Pauline Levitt Endowed Chair in Medicine at Albert Einstein College of Medicine, and is Professor of Radiology and Co-Director (with Dr. Robert Michler) of the Montefiore-Einstein Center for Heart and Vascular Care
Affiliations and expertise
Professor, Department of Medicine, Pauline Levitt Chair in Medicine, Chief, Department of Medicine Division of Cardiology, Co-Director, Montefiore Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, Bronx, New York