A clinical study of left ventricular diastolic properties
Insights
Impaired left ventricular (LV) relaxation is common in heart diseases. Elevated LV preload and stiffness contribute to diastolic dysfunction and heart failure, impacting cardiac function.
Area of Science:
- Cardiology
- Cardiovascular Physiology
- Biomedical Engineering
Background:
- Diastolic dysfunction is a significant contributor to heart failure.
- Understanding left ventricular (LV) diastolic properties is crucial for diagnosing and managing various cardiac conditions.
Purpose of the Study:
- To evaluate left ventricular (LV) diastolic properties in patients with diverse heart diseases.
- To identify abnormalities in LV relaxation, preload, and stiffness across different cardiovascular pathologies.
Main Methods:
- Utilized high-fidelity pressure tracings and LV cineangiography in 150 patients with heart diseases and 22 controls.
- Assessed LV relaxation using the time constant of LV pressure fall (time constant T).
- Quantified LV preload and diastolic elastic stiffness constant (K).
Main Results:
- Impaired LV relaxation (prolonged time constant T) was observed in hypertrophic cardiomyopathy (HCM), congestive cardiomyopathy (CCM), hypertensive heart disease (HHD), coronary artery disease (CAD), mitral stenosis (MS), and mitral regurgitation (MR).
- Elevated LV preload was noted in MR, CCM, and congestive heart failure (CHF).
- Increased diastolic elastic stiffness (K) was found in HCM, HHD, MR, CCM, and CHF.
Conclusions:
- Relaxation abnormalities are prevalent in the majority of patients with heart diseases.
- Elevated LV preload may drive LV dilatation in MR and coincides with CHF in CCM.
- Increased chamber stiffness correlates with increased muscle mass, even without chamber enlargement.
Abstract:
Left ventricular (LV) diastolic properties were evaluated in 150 patient with various heart diseases, including 22 normal subjects, using high fidelity pressure tracing and good quality LV cineangiogram. Impaired LV relaxation was demonstrated in hypertrophic cardiomyopathy (HCM), congestive cardiomyopathy (CCM), hypertensive heart disease (HHD), coronary artery disease (CAD) with and without LV asynergy, mitral stenosis (MS), and mitral regurgitation (MR) with significantly prolonged time constant of the LV pressure fall (time constant T). LV preload, defined as the stress to the ventricle at the end-diastole, was elevated in MR and in patients with CCM and congestive heart failure (CHF). Although LV end-diastolic pressure was high in HCM, preload was in the normal range. Diastolic elastic stiffness constant (K) was elevated in HCM, and slightly (0.05 less than p less than 0.1) high in HHD, and end-diastolic elastic stiffness was elevated in MR, and in patients with CCM and CHF. These observations indicate that the relaxation abnormality is present in the majority of patients with heart diseases. The elevation of preload might be a fundamental cause of LV dilatation in MR by stretching the myocardium, and the elevation of it in CCM coincides with the appearance of CHF. The chamber stiffness is increased in association with an increasing muscle mass without chamber enlargement.
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