DIASTOLIC HEART FAILURE IN CARDIOMYOPATHIES, DIABETES, PERICARDIAL DISEASES, AND PULMONARY HYPERTENSION: DIAGNOSTIC CRITERIA, RISK STRATIFICATION AND THERAPEUTIC MODALITIES

Objectives: Comparative analysis of clinical, morphological, and haemodynamic features, effort tolerance, and quality of life in various forms of diastolic heart failure (DHF) before and after statin±spironolactone therapy. Methods: Pts with cardiomyopathies, diabetes, pericardial disease, and pulmonary hypertension will undergo clinical examination, echocardiography, spiroergometry, and cardiac catheterisation (with endomyocardial biopsy, if indicated). Pts with confirmed DHF will be randomised to rosuvastatin±spironolactone therapy vs. placebo on the top of the standard treatment. Biomarkers (NT pro-BNP, cystatin C, high sensitivity CRP), quality of life assessment, echocardiography, spiroergometry, and cardiac MRI will be performed at baseline, 6-, and 12-months follow-up. Primary end-points of the study will be all-cause mortality and DHF hospitalisations. Secondary end-points will include quality of life analysis, haemodynamic parameters, and effort tolerance. Effect of pericardiectomy in constrictive pericarditis and sildenafil monotherapy vs. combination of sildenafil and bosentan or treprostinil for pulmonary arterial hypertension will be separately analysed. Expected results: A prediction profile will be developed to enable etiological differentiation and risk stratification of patients with DHF. Rosuvastatin and spironolactone therapy are expected to improve primary and/or secondary end-points of the study.