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Prevalence of DHF
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Mortality in SHF and DHF
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DHF??
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Eur Heart J 2011;32:670
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2009 update of
ACC/AHA 2005
guidelines on HF
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Distinct remodeling in DHF vs SHF
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Distinct myocardial structural characteristics in DHF vs SHF
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Eur Heart J 2007;28:2539
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Invasive diagnosis of DHF
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Invasive diagnosis of DHF
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DHF: any change in pre- or afterload induces larger shifts in BP
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JACC 2009;54:410; JACC Img 2008;1:366
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DHF: systolic (l,r) strain, apical rotation; and delayed untwisting
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DHF: exertional dyspnea with exercise tolerance
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Circulation 2006;114:2138; Eur Heart J 2011;32:670
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RISK FACTORS
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Risk factors for diastolic dysfunction
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JACC 2006;47:76; JACC 2007;50:768
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Risk factors for diastolic dysfunction
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Risk factors for diastolic dysfunction
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Risk factors for diastolic dysfunction
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Risk factors for diastolic dysfunction
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MONICA Augsburg
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Risk factors for diastolic dysfunction
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Risk factors for diastolic dysfunction
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Metabolic syndrome - Definitions
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Risk factors for diastolic dysfunction
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DHF pathophysiology
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Extracellular matrix and cardiomyocytes determine myocardial
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Disturbances in cardiomyocyte Ca2+ handling can impair relaxation
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Impaired myocardial energetics in DHF
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Extracellular matrix and cardiomyocytes determine myocardial
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Increased interstitial fibrosis in hypertensive heart disease
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CVF
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ACE-I /ARBs
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Discordant treatment outcome in SHF vs DHF
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Biophys J 2007;93:1719
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Biophys J 2007;93:1719
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Stiff “spring”
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Titin regulates cardiomyocyte intrinsic stiffness
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Antiox & Redox Signal 2008;10:1115
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Van Heerebeek et al, Circulation 2008;117:43
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DHF treatment options
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Roadmap for treatment of DHF
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Spironolactone in DHF
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PDE5-I; ISDN-Hydralaz;
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Nesiritide in acute HF
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PDE5-inhibition with sildenafil in SHF
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Statins;PDE5-I
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Statins in DHF
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