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Post-ischemic diastolic dysfunction

S C Marsch1, S Dalmas, D M Philbin

  • 1Nuffield Department of Anaesthetics, University of Oxford, Radcliffe Infirmary, UK.

Journal of Cardiothoracic and Vascular Anesthesia
|December 1, 1994
PubMed
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Myocardial ischemia and reperfusion significantly impair left ventricular diastolic function, affecting chamber stiffness and relaxation. Many diastolic parameters showed limited recovery after reperfusion, indicating lasting functional deficits.

Area of Science:

  • Cardiovascular Physiology
  • Cardiac Mechanics
  • Myocardial Ischemia Research

Background:

  • While post-ischemic contractile dysfunction is well-documented, post-ischemic diastolic function remains less understood.
  • Left ventricular diastolic function is crucial for adequate cardiac output and is sensitive to ischemic events.

Purpose of the Study:

  • To investigate the effects of myocardial ischemia and reperfusion on left ventricular diastolic function in a canine model.
  • To quantify changes in diastolic parameters, including relaxation, stiffness, and dimensions, during and after ischemia.

Main Methods:

  • Open-chest beagles underwent instrumentation for left ventricular pressure and dimension measurements.
  • Partial occlusion of the left anterior descending coronary artery (LAD) induced ischemia, followed by a reperfusion period.

Related Experiment Videos

  • Pressure-dimension relations were analyzed to derive stiffness constants and assess diastolic parameters like end-diastolic pressure, isovolumic relaxation time constant (tau), and myocardial stiffness.

    • Main Results:

    • Ischemia significantly increased end-diastolic pressure, chamber stiffness, myocardial stiffness, and isovolumic relaxation time constant (tau).
    • Ischemia also induced postsystolic contraction, altered end-diastolic dimensions, and decreased peak negative dP/dt and peak lengthening rate.
    • After reperfusion, only end-diastolic pressure and tau returned to baseline; other parameters like stiffness and peak negative dP/dt showed no recovery.

    Conclusions:

    • Myocardial ischemia induces complex and significant alterations in left ventricular diastolic function, impacting relaxation and myocardial/chamber stiffness.
    • Reperfusion only partially restores some diastolic parameters, with critical measures of diastolic function remaining impaired.
    • These findings highlight the detrimental and persistent effects of ischemia-reperfusion injury on diastolic mechanics.