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Published on: February 14, 2017
Diastolic function in valvular heart disease
O M Hess1, L Felder, H P Krayenbuehl
1Department of Internal Medicine, Medical Policlinic, Cardiology, University Hospital, Zurich, Switzerland.
Insights
Diastolic dysfunction in valvular heart disease involves impaired relaxation and stiffness, potentially worsening after surgery. This cardiac issue can be a primary problem or revealed by exercise-induced pressure changes.
Area of Science:
- Cardiology
- Cardiac Physiology
Background:
- Diastolic dysfunction in valvular heart disease presents with impaired isovolumic relaxation and increased myocardial stiffness.
- These abnormalities can coexist with systolic dysfunction and stem from mechanisms like increased wall stress and altered myocardial structure.
Purpose of the Study:
- To explore the mechanisms and clinical implications of diastolic dysfunction in valvular heart disease.
- To understand the impact of valve replacement surgery on diastolic function.
Main Methods:
- The study reviews existing literature and clinical observations regarding diastolic dysfunction in valvular heart disease.
- Analysis of patient data focusing on myocardial structure, filling pressures, and responses to exercise.
Main Results:
- Postoperative valve replacement may paradoxically worsen diastolic dysfunction due to myocardial remodeling and increased interstitial fibrosis.
- Diastolic dysfunction can persist or manifest during dynamic exercise, indicated by rising left ventricular filling pressures.
Conclusions:
- Diastolic dysfunction is a significant component of valvular heart disease, influenced by surgical interventions.
- Exercise testing can unmask latent diastolic dysfunction, highlighting its clinical relevance in postoperative patients.
Abstract:
Diastolic dysfunction in patients with valvular heart disease is characterized by an impaired isovolumic relaxation, a normal or even enhanced early diastolic filling rate and an increased myocardial stiffness. These abnormalities do not depend on coexisting systolic dysfunction but are often combined. Several mechanisms are responsible for the occurrence of diastolic dysfunction, such as increased wall stress, altered myocardial structure, subendocardial hypoperfusion and/or diastolic calcium overload. Postoperative regression of myocardial hypertrophy is beneficial in regard to wall stress, subendocardial hypoperfusion and calcium overload but diastolic dysfunction might become worse after valve replacement due to a relative increase in interstitial fibrosis consequent to the decrease in myocyte mass (= myocardial remodeling). Persisting diastolic dysfunction with a substantial rise in left ventricular filling pressure can be observed during dynamic exercise in postoperative patients with preoperative severe pressure overload hypertrophy. Thus, diastolic dysfunction can be present as a primary derangement of cardiac function and can be unmasked as an abnormal response of diastolic filling pressure during exercise.
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