Diastolische Herzinsuffizienz und Multimorbidität

 

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Zusammenfassung

Die Herzinsuffizienz ist der häufigste Grund für Krankenhausaufnahmen in Deutschland. Etwa die Hälfte aller Herzinsuffizienzfälle sind auf eine „Herzinsuffizienz mit erhaltener Ejektionsfraktion“, häufig auch als „diastolische Herzinsuffizienz“ tituliert, zurückzuführen. Die hämodynamischen Veränderungen sind geprägt durch eine vermehrte Steifigkeit des linken Ventrikels, was zu erhöhten linksventrikulären Füllungsdrücken, vor allem unter Belastung führt. Die pathophysiologischen Veränderungen bei diastolischer Herzinsuffizienz sind vielfältig, vermutlich ein Grund, warum es so schwer ist, die Erkrankung zu therapieren. Häufiger als Patienten mit Herzinsuffizienz und reduzierter Ejektionsfraktion leiden Patienten mit diastolischer Herzinsuffizienz unter Komorbiditäten. Die wichtigsten Komorbiditäten werden in ihrer Prävalenz, ihrer Bedeutung für den Krankheitsverlauf und den zur Verfügung stehenden Therapieoptionen diskutiert.

Abstract

Heart failure is the most common reason for hospitalisation in Germany. About half of all heart failure cases are caused by „heart failure with preserved ejection fraction“, i. e. “diastolic heart failure”. Hemodynamic alterations are characterized by an increase in left ventricular stiffness, which leads to an increase in left ventricular filling pressures, especially during exercise. Numerous pathophysiologic changes can cause diastolic heart failure which may explain why it is so difficult to treat this disease. Comorbidities are more prevalent in diastolic heart failure as compared to heart failure with reduced ejection fraction. The most important comorbidities are discussed in terms of prevalence, relevance for outcome and therapeutic options.

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