DIASTOLIC DYSFUNCTION AS A CAUSE OF HEART-FAILURE

被引:80
作者
LITWIN, SE
GROSSMAN, W
机构
[1] BETH ISRAEL HOSP, DEPT MED, DIV CARDIOVASC, HARVARD THORNDIKE LAB, BOSTON, MA 02215 USA
[2] BETH ISRAEL HOSP, CHARLES A DANA RES INST, BOSTON, MA 02215 USA
[3] HARVARD UNIV, SCH MED, BOSTON, MA USA
关键词
D O I
10.1016/0735-1097(93)90463-B
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Diastolic dysfunction is an important cause of symptoms in patients with various types of cardiac disease, Increased left ventricular diastolic pressure may lead to pulmonary congestion, even in the setting of normal left ventricular systolic function. Although the physiology of diastolic function is complex, left ventricular diastolic pressure may become elevated through one of three broad mechanisms. Abnormalities intrinsic to the left ventricle may include 1) impaired left ventricular relaxation, a finding that is common in most cardiac diseases and may be particularly important during ischemia; 2) increased left ventricular wall thickness relative to cavity volume, which will shift the diastolic pressure-volume relation such that the same volume is associated with a higher pressure; and 3) increased myocardial stiffness, which is thought to be associated with interstitial fibrosis or scar tissue formation. In addition, diastolic pressures may become elevated because of factors extrinsic to the left ventricle. These may include 1) increased central blood volume, which will increase left ventricular pressure without altering the left ventricular pressure-volume relation; and 2) ventricular interaction mediated by pericardial restraint, which may cause a parallel upward shift of the diastolic pressure-volume relation. Treatment of the factors extrinsic to the left ventricle fends to be much more successful than treating abnormalities that are intrinsic to the ventricle. Improved understanding of myocardial relaxation at the cellular level and delineation of the molecular regulation of myocyte hypertrophy and fibroblast proliferation may lead to new and innovative approaches to the treatment of heart failure.
引用
收藏
页码:A49 / A55
页数:7
相关论文
共 55 条
[1]   SIMULTANEOUS ASSESSMENT OF LEFT-VENTRICULAR SYSTOLIC AND DIASTOLIC DYSFUNCTION DURING PACING-INDUCED ISCHEMIA [J].
AROESTY, JM ;
MCKAY, RG ;
HELLER, GV ;
ROYAL, HD ;
ALS, AV ;
GROSSMAN, W .
CIRCULATION, 1985, 71 (05) :889-900
[2]   LEFT-VENTRICULAR DIASTOLIC FUNCTION IN PATIENTS WITH LEFT-VENTRICULAR SYSTOLIC DYSFUNCTION DUE TO CORONARY-ARTERY DISEASE AND EFFECT OF NICARDIPINE [J].
ARONEY, CN ;
SEMIGRAN, MJ ;
DEC, GW ;
BOUCHER, CA ;
FIFER, MA .
AMERICAN JOURNAL OF CARDIOLOGY, 1991, 67 (09) :823-829
[3]   EFFECTS OF HYPERTROPHY ON THE CORONARY CIRCULATION [J].
BACHE, RJ .
PROGRESS IN CARDIOVASCULAR DISEASES, 1988, 30 (06) :403-440
[4]   EFFECT OF LATHYROGEN BETA-AMINO PROPRIONITRILE (BAPN) ON MECHANICAL-PROPERTIES OF EXPERIMENTALLY HYPERTROPHIED RAT CARDIAC-MUSCLE [J].
BING, OHL ;
FANBURG, BL ;
BROOKS, WW ;
MATSUSHITA, S .
CIRCULATION RESEARCH, 1978, 43 (04) :632-637
[6]  
BRISTOW MR, 1990, CIRCULATION, V82, P12
[7]   EXERCISE-INDUCED ISCHEMIA - THE INFLUENCE OF ALTERED RELAXATION ON EARLY DIASTOLIC PRESSURES [J].
CARROLL, JD ;
HESS, OM ;
HIRZEL, HO ;
KRAYENBUEHL, HP .
CIRCULATION, 1983, 67 (03) :521-528
[8]   THE DIFFERENTIAL-EFFECTS OF POSITIVE INOTROPIC AND VASODILATOR THERAPY ON DIASTOLIC PROPERTIES IN PATIENTS WITH CONGESTIVE CARDIOMYOPATHY [J].
CARROLL, JD ;
LANG, RM ;
NEUMANN, AL ;
BOROW, KM ;
RAJFER, SI .
CIRCULATION, 1986, 74 (04) :815-825
[9]   A COMPARISON OF ENALAPRIL WITH HYDRALAZINE ISOSORBIDE DINITRATE IN THE TREATMENT OF CHRONIC CONGESTIVE-HEART-FAILURE [J].
COHN, JN ;
JOHNSON, G ;
ZIESCHE, S ;
COBB, F ;
FRANCIS, G ;
TRISTANI, F ;
SMITH, R ;
DUNKMAN, WB ;
LOEB, H ;
WONG, ML ;
BHAT, G ;
GOLDMAN, S ;
FLETCHER, RD ;
DOHERTY, J ;
HUGHES, CV ;
CARSON, P ;
CINTRON, G ;
SHABETAI, R ;
HAAKENSON, C .
NEW ENGLAND JOURNAL OF MEDICINE, 1991, 325 (05) :303-310
[10]  
COLLINS AG, 1990, J AM WATER WORKS ASS, V82, P44