Diastolic dysfunction in the elderly--the interstitial issue.

Diastolic dysfunction is increasingly recognized as a cause of congestive heart failure. Meta-analyses of earlier studies of this disorder suggest that 40%-50% of patients with the congestive heart failure syndrome have preserved left ventricular systolic function, with current estimates ranging up to 74%. Among patients >or=65 years of age with congestive heart failure, 55% of all subjects and 67% of women had normal systolic function.

Cardiac fibrosis as a cause of diastolic dysfunction.

Background: Diastolic dysfunction is increasingly recognized as a cause of symptomatic heart failure, including the clinical syndrome congestive heart failure (CHF). Meta-analyses of earlier studies of this disorder suggest 40-50% of patients with congestive heart failure have preserved left ventricular systolic function. Conditions associated with diastolic dysfunction are diverse and most commonly include ischemic cardiomyopathy with previous myocardial infarction(s) and hypertensive heart disease.

CHF: circulatory homeostasis gone awry.

The role of the renin-angiotensin-aldosterone system (RAAS) is integral to salt and water retention, particularly by the kidneys. Over time, positive sodium balance leads first to intra- and then to extravascular volume expansion, with subsequent symptomatic heart failure. This report examines the role of the RAAS in regulating a less well recognized component essential to circulatory homeostasis--central blood volume.