Diastolic function in left ventricular hypertrophy: clinical and experimental relationships
B H Lorell1, C S Apstein, E O Weinberg
1Cardiac Muscle Research Laboratory, Boston University School of Medicine, Massachusetts.
European Heart Journal
|November 1, 1990
Summary
Distinguishing systolic and diastolic dysfunction is key for patients with left ventricular hypertrophy and heart failure. Diastolic dysfunction is suspected with elevated left ventricular diastolic pressure but normal chamber size and preserved systolic function.
Area of Science:
- Cardiology
- Heart Failure Research
- Cardiac Physiology
Background:
- Evaluating patients with left ventricular hypertrophy (LVH) and congestive heart failure (CHF) necessitates differentiating systolic dysfunction from diastolic dysfunction.
- Diastolic dysfunction, characterized by impaired relaxation and filling, is a critical consideration in CHF patients with LVH.
- Understanding the underlying mechanisms of diastolic dysfunction in LVH is crucial for effective patient management.
Purpose of the Study:
- To highlight the importance of distinguishing between systolic and diastolic etiologies in patients presenting with LVH and CHF.
- To identify clinical indicators for suspecting predominant diastolic dysfunction in this patient population.
- To review the multifaceted and controversial mechanisms contributing to diastolic dysfunction in cardiac hypertrophy.
Main Methods:
- Clinical evaluation focusing on left ventricular diastolic pressure, chamber volume/dimensions, and systolic shortening.
- Review of proposed mechanisms for diastolic dysfunction in cardiac hypertrophy.
- Consideration of factors such as left ventricular geometry, myocardial composition (fibrosis, collagen), and dynamic modulators.
Main Results:
- Predominant diastolic dysfunction should be suspected when elevated left ventricular diastolic pressure is observed alongside normal diastolic chamber volumes/dimensions and preserved systolic shortening.
- Multiple, often controversial, mechanisms contribute to diastolic dysfunction in cardiac hypertrophy.
- These include alterations in left ventricular geometry, myocardial fibrosis, collagen changes, and dynamic factors affecting relaxation.
Conclusions:
- Accurate differentiation between systolic and diastolic dysfunction is vital for managing patients with LVH and CHF.
- Hypertrophied cardiac muscle appears particularly vulnerable to diastolic dysfunction under stress, such as hypoxia or ischemia.
- Further research into the complex mechanisms of diastolic dysfunction is warranted for improved therapeutic strategies.
Related Concept Videos
01:20Mitral Regurgitation I: Introduction
Mitral regurgitation is characterized by the backward circulation of blood from the left ventricle to the left atrium during systole, a phase of the cardiac cycle when the heart contracts and pumps blood out of the chambers. This abnormal flow occurs primarily due to the dysfunction of the mitral valve or its supporting structures, which include the mitral leaflets, chordae tendineae, annulus, and papillary muscles.Etiology and Mechanisms:Primary Mitral Regurgitation: This type arises from...
01:22Mitral Stenosis I: Introduction
Mitral Valve Stenosis (MVS) is a heart condition where the mitral valve narrows, impeding blood circulation from the left atrium to the left ventricle. The etiology and pathophysiology of this condition are multifaceted, leading to a cascade of cardiovascular complications.Causes of Mitral Valve StenosisRheumatic Heart Disease: It is the main cause of mitral valve stenosis, particularly in developing nations. This condition arises from rheumatic fever, an inflammatory illness resulting from...
01:22Aortic Regurgitation II: Clinical Features and Diagnostic Tests
Aortic valve regurgitation (AR) occurs when the aortic valve fails to close properly, allowing blood to flow backward from the aorta into the left ventricle. This backflow can result in two distinct clinical presentations: acute and chronic AR, each characterized by its own set of symptoms and physical findings.Acute Aortic RegurgitationAcute AR presents with a sudden onset of severe symptoms. Patients typically experience profound dyspnea (shortness of breath), chest pain, and signs of left...
01:29Heart Failure II: Pathophysiology
Systolic Heart Failure and Compensatory MechanismsSystolic heart failure (also termed HFrEF, Heart Failure with Reduced Ejection Fraction) is the most prevalent type of heart filure. It results in a decreased volume of blood being pumped from the ventricle. The aortic arch and carotid sinuses have baroreceptors that detect reduced blood pressure, triggering the sympathetic nervous system (SNS) to release epinephrine and norepinephrine. Initially, this response aims to boost heart rate and...
01:30Cardiomyopathy II: Dilated Cardiomyopathy
Dilated cardiomyopathy, or DCM, is a progressive myocardial disorder characterized by ventricular chamber dilation and contractile dysfunction.EtiologyVarious factors can cause DCM, including hypertension and heavy alcohol intake, which contribute to the weakening and enlargement of the heart muscle. Viral infections, such as Coxsackievirus B, adenoviruses, and influenza, can lead to DCM by causing inflammation and damage to heart tissue. Certain chemotherapeutic agents, including daunorubicin,...
01:29Cardiomyopathy III: Hypertrophic Cardiomyopathy
Hypertrophic cardiomyopathy, or HCM, is an autosomal dominant genetic disorder characterized by asymmetric left ventricular hypertrophy without ventricular dilation. It is more common in men and is typically diagnosed in young, athletic adults.EtiologyHCM is primarily genetic and is caused by mutations in genes encoding sarcomeric proteins. Researchers have identified over 1400 mutations across at least 11 different genes. Among these, the most frequently occurring mutations are found in the...