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Concepts related to the study of diastolic function: a personal commentary
1Albert Einstein College of Medicine of Yeshiva University, Bronx, NY 10461, USA.
Insights
Understanding diastolic function requires examining the interplay between the atrioventricular pressure difference and mitral valve impedance. Further research into left atrial properties is crucial for a complete understanding of diastolic indices.
Area of Science:
- Cardiology
- Physiology
- Biomedical Engineering
Background:
- Diastolic function is crucial for cardiac health, yet its complexities are not fully understood.
- The transmitral flow wave is influenced by atrioventricular pressure gradients and mitral valve impedance.
- Left atrial properties significantly impact early diastolic filling, a factor often overlooked.
Purpose of the Study:
- To discuss the fundamental physiological principles governing diastolic function.
- To highlight the importance of left atrial properties in diastolic assessment.
- To encourage further research into both macro and micro levels of diastolic function.
Main Methods:
- Review of existing literature and physiological principles.
- Analysis of factors influencing left ventricular (LV) pressure.
- Discussion of macro-level diastolic function assessment.
Main Results:
- LV pressure is a result of myocardial deactivation, passive properties, deformation, and viscoelasticity.
- Atrioventricular pressure difference and mitral valve impedance dictate transmitral flow.
- The role of left atrial properties in diastolic function warrants greater attention.
Conclusions:
- A comprehensive understanding of diastolic function requires integrating knowledge of basic physiology and advanced assessment techniques.
- Further investigation into left atrial mechanics and pressure dynamics is essential.
- Continued development of new modalities for studying diastolic function is vital.
Abstract:
The phasic character of the transmitral flow wave is determined by the AV pressure difference and the impedance of the mitral valve complex. The measured LV pressure is determined by the complex contributions from 4 sources: rate and extent of deactivation, passive myocardial properties, deformation due to shape change, and viscoelasticity. An understanding of the functional value of diastolic indices is helped by an understanding of the basic physiology. Many questions remain unanswered at both the macro level, which has been the focus of this commentary, and the micro level where the ultimate source of function arises. New modalities for the study of diastolic function at the macro level are constantly under development, and progress is being made at the micro level. It is unfortunate that the role of left atrial properties has not received the attention required, considering that it is more than 10 years since Ishida et al. demonstrated the importance of LA pressure in creating the early filling wave. I trust that the reader understands that this paper is not meant to be a comprehensive review, but rather a discussion of basic principles from the very personal, albeit limited, point of view of my years of collaboration with colleagues from Japan. I dedicate this paper to all my former Fellows included among the authors in References 1-14, whose contributions to the study of diastolic function deserve the highest praise.