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Diastolic heart function--pathophysiology, characterization, and therapeutic approaches
D Modersohn1, T Walde, L Bruch
1Humboldt University Berlin, Department of Cardiology, Germany.
Insights
Assessing diastolic cardiac function requires multiple parameters due to its complex active and passive factors. Comprehensive evaluation, including invasive and noninvasive methods, is crucial for accurate diagnosis and effective therapy in heart conditions.
Area of Science:
- Cardiology
- Cardiovascular Physiology
Background:
- Diastolic cardiac function is increasingly recognized for early detection of cardiac disease.
- It involves complex active and passive factors, necessitating a multi-parameter assessment.
Purpose of the Study:
- To review various diastolic function parameters.
- To discuss their role in assessing cardiac function and responsiveness to therapy in conditions like hypertrophy, cardiomyopathy, and coronary heart disease.
Main Methods:
- Comprehensive analysis requires invasive procedures (pressure and volume measurements) and noninvasive techniques (echocardiography, radionuclear ventriculography).
- Assessment includes filling parameters, stress-strain relationships, and complementary diagnostics like pulmonary pressure and stress testing.
Main Results:
- No single parameter is sufficient for a complete diastolic function analysis.
- Therapies must consider potential impacts on diastolic function, especially concerning myocardial oxygen consumption.
Conclusions:
- Effective evaluation of diastolic cardiac function integrates invasive and noninvasive diagnostics.
- Understanding parameter responsiveness to therapy is key for managing cardiac conditions.
Abstract:
In recent years diastolic cardiac function has attracted increasing attention since parameters of diastolic function were found to be altered earlier or more specifically than parameters of systolic function. Diastolic cardiac function is determined by both active (muscular relaxation, redistribution of calcium, synchronization, etc.) and passive (myocardial structure, fibrosis, etc.) factors. As a consequence, a comprehensive assessment of diastolic cardiac function cannot be based on one single parameter. For a complete analysis of diastolic function it is necessary to perform invasive diagnostic procedures involving the measurement of atrial and ventricular pressures, as well as the registration of volume changes with a high time resolution. In addition, it is necessary to measure wall thickness and ventricular configuration, so that apart from filling parameters the stress-strain relationship can be obtained. Noninvasive techniques (Doppler echocardiography, radionuclear ventriculography, apexcardiography) may suggest alterations in diastolic function as well. They ought to be complemented by additional diagnostic procedures (pulmonary pressure, stress testing, etc.). Therapy must consider potentially harmful effects on diastolic function parameters, particularly if changes in myocardial oxygen consumption may result (heart rate, parietal wall stress). Calcium antagonists (verapamil, diltiazem, nifedipine), phosphodiesterase inhibitors (milrinone), beta-adrenergic agonists and antagonists with vasodilating effects (e.g., celiprolol) all have beneficial effects on diastolic myocardial function. A range of diastolic function parameters is being reviewed in the following paper. Their role in the estimation of cardiac function and their responsiveness to therapy in hypertrophy, cardiomyopathy, and coronary heart disease is being discussed.