The Rule of ACE Inhibitor in diastolic heart failure

diastolic heart failure is clinical sysndrom characterized by the symtoms and sign of heart failure, a preserved ejection fraction (EF), and abnormal diastolic function.

treatment of diastolic heart failure can be framed in 3 step :

1. treatement should target symtom reducion, principally by decreasing pulmanary venous presure at rest and during exertion.
2. treatment should target the pathological disease that caused the diastolic hearth failure.
3. treatment should targeet the underlying mechanisms that are altered by the disease procsess.

ACE inhibitor redue systemic vascular resistance, artial presure, LV and right ventricular end-diastolic ressures, cardiac work, and myocardial oxygen consumtion and increase cardiac output. beside that ace inhibitor also improve HF associated with normal LV ejection fraction by decreaseng afterload, lowering elevated blood pressure, decreasing LV mass and artial and arteriolar wall thicness and stiffness by improving LV relaxation and by attenuating the coronary Vasocontriction of angiotensin II.
few observatioanl data available showed ACE inhibitor improved NYHA functiooanl class, LVdiastolic function, mortality and quality of life scores in diastolic heart failure. however data form large scale, prospective, randomized, placebo controlled studied investigating the efficacy of ACE inhibitor on cardiovaskuler mortality and morbidity are needed to establish in the treatment of diastolic HF.

refrence
ASMIHA 16, articel by Idris Idham
National cardiovasculer center harapan kita - jakarta