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Left ventricular dynamics, energetics and coronary hemodynamics in hypertrophic heart disease

B E Strauer

    European Heart Journal
    |January 1, 1983
    PubMed

    Insights

    Left ventricular hypertrophy in chronic heart disease can be categorized into low-stress and high-stress types, impacting myocardial oxygen consumption. High-stress hypertrophy is linked to impaired function and increased oxygen demand, correlating with elevated systolic wall stress.

    Area of Science:

    • Cardiology
    • Physiology
    • Pathophysiology

    Background:

    • Left ventricular hypertrophy (LVH) is a common adaptation in chronic heart disease.
    • The relationship between cardiac structure, mechanical load, and energy metabolism is complex.
    • Understanding these relationships is crucial for diagnosing and managing heart conditions.

    Purpose of the Study:

    • To analyze the relationship between left ventricular mass, mass-to-volume ratio, systolic wall stress, and myocardial oxygen consumption in patients with chronic heart disease.
    • To differentiate types of inappropriate LVH based on stress and functional parameters.
    • To investigate the correlation between left ventricular oxygen consumption and systolic wall stress.

    Main Methods:

    • Analysis of left ventricular mass, mass-to-volume ratio, systolic wall stress, and myocardial oxygen consumption (MVO2) in 187 patients.
    • Categorization of LVH into low-stress and high-stress types based on defined criteria.
    • Correlation analysis between MVO2 per viable mass unit and left ventricular systolic wall stress.

    Main Results:

    • Two types of inappropriate LVH were identified: low-stress (increased mass/volume ratio, normal function, normal/reduced MVO2) and high-stress (normal/low mass/volume ratio, impaired function, increased MVO2).
    • Left ventricular oxygen consumption per viable mass unit significantly correlated with left ventricular systolic wall stress (range: 100-450 x 10^3 dynes/cm^2).
    • Coronary reserve can be diminished by vascular or myocardial resistance, impacting oxygen supply even with normal coronary arteries.

    Conclusions:

    • Systolic wall stress is a key determinant of left ventricular oxygen consumption in chronic heart disease.
    • Abnormalities in coronary resistance, both vascular and myocardial, contribute to reduced myocardial oxygen supply.
    • These findings highlight the importance of mechanical load and coronary microcirculation in the pathophysiology of chronic heart disease.

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