Skip to main content

Abnormalities in Cardiac Relaxation and Other Forms of Diastolic Dysfunction

  • Chapter
Congestive Heart Failure
  • 447 Accesses

Abstract

In 1651, William Harvey wrote: “I saw the heart and its auricles begin to move, to contract and to relax . . . The motion and action of the heart is a kind of swallowing and transfusion of the blood from the veins into the arteries . . .”1 In this vivid description, Harvey made it clear that the heart had two separate functions: the systolic function and the diastolic function.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Harvey W. An Anatomical Disputation Concerning the Movement of the Heart and Blood in Living Creatures. Oxford: Blackwell; 1976:44–51.

    Google Scholar 

  2. Bonow RO, Bacharach SL, Green MV, et al. Impaired left ventricular diastolic filling in patients with coronary artery disease: assessment with radionuclide cineangiography. Circulation. 1981;64:315–323.

    Article  PubMed  CAS  Google Scholar 

  3. Bonow RO, Frederick TM, Bacharach SL, et al. Atrial systole and left ventricular filling in hypertrophic cardiomyopathy: effect of verapamil. Am J Cardiol. 1983; 51:1386–1391.

    Article  PubMed  CAS  Google Scholar 

  4. Grossman W, McLaurin LP, Rollett EL. Alterations in left ventricular relaxation and diastolic compliance in congestive cardiomyopathy. Cardiovasc Res. 1979;13:514–522.

    Article  PubMed  CAS  Google Scholar 

  5. Reduto LA, Wickmeyer WJ, Young JB, et al. Left ventricular diastolic performance at rest and during exercise in patients with coronary artery disease. Assessment with first-pass radionuclide angiography. Circulation. 1981;63: 1228–1237.

    Article  PubMed  CAS  Google Scholar 

  6. Papapietro SE, Coghlan HC, Zissermann D, Russell RO, Rackley CE, Rogers WJ. Impaired maximal rate of left ventricular relaxation in patients with coronary artery disease and left ventricular dysfunction. Circulation. 1979;59:984–991.

    PubMed  CAS  Google Scholar 

  7. Rousseau MF, Veriter C, Detry JMR, Brasseur LA, Pouleur H. Impaired early left ventricular relaxation in coronary artery disease. Effects of intracoronary Nifedipine. Circulation. 1980;62:764–772.

    PubMed  CAS  Google Scholar 

  8. Rousseau MF, Pouleur H, Detry JM, Brasseur L. Impaired left ventricular relaxation in patients with aortic or mitral regurgitation. Am J Cardiol. 1982;49:990.

    Article  Google Scholar 

  9. Pouleur H, Rousseau MF, van Eyll C, Charlier AA. Assessment of regional left ventricular relaxation in patients with coronary artery disease: importance of geometric factors and changes in wall thickness. Circulation. 1984;69:696–702.

    Article  PubMed  CAS  Google Scholar 

  10. Lorell BH, Grossman W. Cardiac hypertrophy: consequences for diastole. J Am Coll Cardiol. 1987;9:1189–1193.

    Article  PubMed  CAS  Google Scholar 

  11. Peterson KL, Tsuji J, Johnson A, DiDonna J, LeWinter M. Diastolic Left ventricular pressure-volume and stressstrain relations in patients with valvular aortic stenosis and left ventricular hypertrophy. Circulation. 1978;58:77.

    PubMed  CAS  Google Scholar 

  12. Eichhorn P, Grimm J, Koch R, Hess O, Carroll J, Krayenbuehl P. Left ventricular relaxation in patients with left ventricular hypertrophy secondary to aortic valve disease.Circulation. 1982;65:1395–1404.

    Article  PubMed  CAS  Google Scholar 

  13. Hess OM, Schneider J, Koch R, Bamert C, Grimm J, Krayenbuehl HP. Diastolic function and myocardial structure in patients with myocardial hypertrophy. Special reference to normalized viscoelastic data. Circulation. 1981;63:360–371.

    Article  PubMed  CAS  Google Scholar 

  14. Hess OM, Ritter M, Schneider J, Grimm J, Turina M, Krayenbuel HP. Diastolic stiffness and myocardial structure in aortic valve disease before and after valve replacement. Circulation. 1984;69:855–865.

    Article  PubMed  CAS  Google Scholar 

  15. Grossman W, Barry WH. Diastolic pressure-volume relations in the diseased heart. Fed Proc. 1980;39:148–155.

    PubMed  CAS  Google Scholar 

  16. Grossman W. Diastolic dysfunction and Congestive Heart Failure.Circulation. 1990;81–2:III1–III7.

    Google Scholar 

  17. Spotnitz HM, Sonnenblick EH. Structural conditions in the hypertrophied and failing heart. In: Mason DT, ed. Congestive Heart Failure. New York: York Medical Books; 1976:13–24.

    Google Scholar 

  18. Magorien DJ, Shaffer P, Bush CA, et al. Assessment of left ventricular pressure-volume relations using gated radionuclide angiography, echocardiography, and micromanometer pressure recordings.Circulation. 1983;67: 844–853.

    Article  PubMed  CAS  Google Scholar 

  19. McKay RG, Aroesty JM, Heer GV, et al. Left ventricular pressure-volume diagrams and end-systolic pressure-volume relations in human beings. J Am Coll Cardiol. 1984;3:301–312.

    Article  PubMed  CAS  Google Scholar 

  20. Ludbrook PA, Byrne JD, Kurnik PB, McKnight RC. Influence of reduction of preload and afterload by nitroglycerin on left ventricular diastolic pressure-volume relations and relaxation in man. Circulation. 1977;56: 937–943.

    PubMed  CAS  Google Scholar 

  21. Pouleur H, Rousseau MF, van Eyll C, Gurné O, Hanet C, Charlier AA. Impaired regional diastolic distensibility in coronary artery disease: relations with dynamic left ventricular compliance. Am Heart J. 1986;112:721–728.

    Article  PubMed  CAS  Google Scholar 

  22. Weber KT, Janicki JS. Angiotensin and the remodelling of the myocardium. Br J Clin Pharmacol. 1989;28:141S–150S.

    PubMed  Google Scholar 

  23. Weber KT. Cardiac interstitium in health and disease: the fibrillar collagen network. J Am Coll Cardiol. 1989;13–7:1637–1652.

    Article  Google Scholar 

  24. Brilla CG, Pick R, Tan LB, Janicki JS, Weber KT. Remodeling of the rate right and left ventricles in experimental hypertension. Circ Res. 1990;67:1355–1364.

    PubMed  CAS  Google Scholar 

  25. Hittinger L, Shannon RP, Bishop SP, Gelpi RJ, Vatner SF. Subendomyocardial exhaustion of blood flow reserve and increased fibrosis in conscious dogs with heart failure. Circ Res. 1989;65:971–980.

    PubMed  CAS  Google Scholar 

  26. Vatner SF, Shannon R, Hittinger L. Reduced subendocardial coronary reserve. A potential mechanism for impaired diastolic function in the hypertrophied and failing heart. Circulation. 1990;81:(111)8–14.

    Google Scholar 

  27. Ross J Jr. Acute displacement of the diastolic pressure-volume curve of the left ventricle: role of the pericardium and the right ventricle. Circulation. 1979;59:32–37.

    PubMed  Google Scholar 

  28. Ludbrook PA, Byrne JD, McKnight RC. The influence of right ventricular hemodynamics on left ventricular pressure-volume relations in man. Circulation. 1979;59: 21–28.

    PubMed  CAS  Google Scholar 

  29. Rousseau MF, Gurné O, van Eyll C, Benedict CR, Pouleur H. Effects of benazeprilat on left ventricular systolic and diastolic function and neurohumoral status in patients with ischemic heart disease. Circulation. 1990;81:III-123–129.

    Google Scholar 

  30. Konstam MA, Kronenberg MW, Udelson JE, et al. Effect of acute angiotensin converting enzyme inhibition on left ventricular filling in patients with Congestive Heart Failure. Relation to right ventricular volumes. Circulation. 1990;81:III-115–122.

    Google Scholar 

  31. Katz AM. Cellular mechanisms in Congestive Heart Failure. Am J Cardiol. 1988;62:3A–8A.

    Article  PubMed  CAS  Google Scholar 

  32. Opie LH, Nayler W, Gevers W. Calcium fluxes. In: Opie L, ed. The Heart. Orlando: Grune & Stratton; 1984:88–97.

    Google Scholar 

  33. Bristow MR, Ginsburg R, Umans V, et al. β 1 and β 2-adrenergic-receptor subpopulations in nonfailing and failing human ventricular myocardium: coupling of both receptor subtypes to muscle contraction and selective β 1-receptor down-regulation in heart failure. Circ Res. 1986;59:297–309.

    PubMed  CAS  Google Scholar 

  34. Lakatta EG. Excitation-contraction. In: Weisfeldt ML, ed. The Aging Heart. New York: Raven Press; 1980:77–100.

    Google Scholar 

  35. Mann T, Goldberg S, Mudge GH, Grossman W. Factors contributing to altered left ventricular diastolic properties during angina pectoris. Circulation. 1979;59:14–20.

    PubMed  CAS  Google Scholar 

  36. Pouleur H, Rousseau MF. Regional diastolic dysfunction in coronary artery disease: clinical and therapeutic implications. In: Grossman W, Lorell BH, eds. Diastolic Relaxation of the Heart. Boston: Martinus Nijhoff Publishing; 1988:245–254.

    Google Scholar 

  37. Wisneski JA, Gertz EW, Neese RA, Gruenke LD, Craig JC. Dual carbon-labeled isotope experiments using D-(6–14C)glucose and L-(l,2,3–13C3)lactate: a new approach for investigating human myocardial metabolism during ischemia. J Am Coll Cardiol. 1985;5:1138–1146.

    Article  PubMed  CAS  Google Scholar 

  38. Gertz EW, Wisneksi JA, Neese R, Bristow JD, Searle GL, Hanlon JT. Myocardial lactate metabolism: evidence of lactate release during net chemical extraction in man. Circulation. 1981;63:1273–1279.

    Article  PubMed  CAS  Google Scholar 

  39. McKay RG, Aroesty JM, Heller GV, et al. The pacing stress test reexamined: correlation of pacing-induced hemodynamic changes with the amount of myocardium at risk. J Am Coll Cardiol. 1984;3:1469–1481.

    Article  PubMed  CAS  Google Scholar 

  40. De Kock M, Melin JA, Pouleur H, Rousseau MF. Alterations in myocardial metabolism and function at rest in stable angina pectoris: relations with the amount of exercise-induced Thallium-201 perfusion defect. Cathet Cardiovasc Diagn. 1986;12:391–398.

    Article  PubMed  Google Scholar 

  41. Marcus ML, Harrison DG, Chilian WM, et al. Alterations in the coronary circulation in hypertrophied ventricles. Circulation. 1987;75(suppl I):I19–I25.

    PubMed  CAS  Google Scholar 

  42. Morgan JP, Erny RE, Allen PD, Grossman W, Gwathmey JK. Abnormal intracellular calcium handling, a major cause of systolic and diastolic dysfunction in ventricular myocardium from patients with heart failure. Circulation. 1990;81–2:III21–III32.

    Google Scholar 

  43. de la Bastie D, Levitsky D, Rappaport L, et al. Function of the sarcoplasmic reticulum and expression of its Ca2+-ATPase gene in pressure overload-induced cardiac hypertrophy in the rat. Circ Res. 1990;66:554–564.

    PubMed  Google Scholar 

  44. Lorell BH, Schunkert H, Grice WN, Tang SS, Apstein CS, Dzau VJ. Alteration in cardiac angiotensin converting enzyme activity in pressure overload hypertrophy. Circulation. 1989;80:11–297. Abstract.

    Google Scholar 

  45. Weber KT, Janicki JS, Shroff SG. The heart as a mechanical pump. In: Weber KT, Janicki JS, eds. Cardio-Pulmonary Exercise Testing. Philadelphia: Saunders; 1986:34–76.

    Google Scholar 

  46. Brutsaert DL, Housmans PR, Goethals MA. Dual control of relaxation. Its role in the ventricular function in the mammalian heart. Circ Res. 1980;47:637–652.

    PubMed  CAS  Google Scholar 

  47. Watanabe J, Levine MJ, Bellotto F, Johnson RG, Grossman W. Effect of coronary venous pressure on left ventricular diastolic distensibility. Circ Res. 1990;67:923–932.

    PubMed  CAS  Google Scholar 

  48. Bonow RO. Regional left ventricular nonuniformity. Effects on left ventricular diastolic function in ischemic heart disease, hypertrophic cardiomyopathy, and the normal heart. Circulation. 1990;81(III):54–65.

    Google Scholar 

  49. Hanet C, Rousseau MF, van Eyll C, Pouleur H. Effects of nicardipine on regional diastolic left ventricular function in patients with angina pectoris. Circulation. 1990; 81:111–148–154.

    Google Scholar 

  50. Braunwald E, Ross J, Sonnenblick EH. Heart failure. In: Mechanisms of Contraction of the Normal and Failing Heart. Boston: Little, Brown and Company; 1976:309–356.

    Google Scholar 

  51. Matsuda Y, Toma Y, Ogawa H, et al. Importance of left atrial function in patients with myocardial infarction. Circulation. 1983;67:566–571.

    Article  PubMed  CAS  Google Scholar 

  52. Linderer T, Chatterjee K, Parmley WW, Sievers RE, Glantz SA, Tyberg J. Influence of atrial systole on the Frank-Starling relation and the end-diastolic pressure-diameter relation of the left ventricle. Circulation. 1983; 67:1045–1053.

    Article  PubMed  CAS  Google Scholar 

  53. Pouleur H, van Eyll C, Cheron P, Hanet C, Charlier AA, Rousseau MF. Changes in left ventricular filling dynamics after long-term xamoterol therapy in ischemic left ventricular dysfunction. Heart Failure. 1986;2:176–184.

    Google Scholar 

  54. Franciosa JA, Park M, Levine TB. Lack of correlation between exercise capacity and indexes of resting left ventricular performance in heart failure. Am J Cardiol. 1981;47:33–39.

    Article  PubMed  CAS  Google Scholar 

  55. McKirnan MD, Sullivan M, Jensen D, Froelicher VF. Treadmill performance and cardiac function in selected patients with coronary heart disease. J Am Coll Cardiol. 1984;3:253–261.

    Article  PubMed  CAS  Google Scholar 

  56. Packer M. Abnormalities of diastolic function as a potential cause of exercise intolerance in chronic heart failure. Circulation. 1990;81(III):78–86.

    Google Scholar 

  57. Balfour IC, Arensman FW, Eubig C, Garrido M, Jones C. Abnormal ventricular filling in sickle cell anemia. J Am Coll Cardiol. 1987;9:58A.

    Google Scholar 

  58. Kitzman DW, Higginbotham MB, Cobb FR, Sheikh KH, Sullivan MJ. Exercise intolerance in patients with heart failure and preserved left ventricular systolic function: failure of the Frank-Starling mechanism. J Am Coll Cardiol. 1991;17:1065–1072.

    Article  PubMed  CAS  Google Scholar 

  59. Oldershaw PJ, Dawkins KD, Ward DE, Gibson DG. Diastolic mechanisms of impaired exercise tolerance in aortic valve disease. Br Heart J. 1983;49:568–573.

    Article  PubMed  CAS  Google Scholar 

  60. Pouleur H, Hanet C, Rousseau MF, van Eyll C. Relation of diastolic function and exercise capacity in ischemic left ventricular dysfunction. Role of β-agonists and β-antagonists. Circulation. 1990;82(I):89–96.

    Google Scholar 

  61. Cuocolo A, Sax FL, Brush JE, Maron BJ, Bacharach SL, Bonow RO. Left ventricular hypertrophy and impaired diastolic filling in essential hypertension. Circulation. 1990;81–3:978–986.

    Article  Google Scholar 

  62. Rodeheffer RJ, Gerstenblith G, Becker LC, Fleg JL, Weisfledt ML, Lakatta EG. Exercise cardiac output is maintained with advancing age in healthy human subjects: cardiac dilatation and increased stroke volume compensate for a diminished heart rate. Circulation. 1984;69:203–213.

    Article  PubMed  CAS  Google Scholar 

  63. McKay RG, Pfeffer MA, Pasternak RC, et al. Left ventricular remodeling after myocardial infarction: a corollary to infarct expansion. Circulation. 1986;74:693–702.

    Article  PubMed  CAS  Google Scholar 

  64. Pfeffer JM, Pfeffer MA, Braunwald E. Influence of chronic Captopril therapy on the infarcted left ventricle of the rat. Circ Res. 1985;57:84–95.

    PubMed  CAS  Google Scholar 

  65. Ross J Jr. Afterload mismatch and preload reserve: a conceptual framework for the analysis of ventricular function. Progr Cardiovasc Dis. 1976;18:255–264.

    Article  Google Scholar 

  66. Sharpe N, Smith H, Murphy J, Hannan S. Treatment of patients with symptomless left ventricular dysfunction after myocardial infarction. Lancet. 1988:256–259.

    Google Scholar 

  67. Pfeffer MA, Lamas GA, Vaughan DE, Parisi AF, Braunwald E. Effect of Captopril on progressive ventricular dilatation after anterior myocardial infarction. N Engl J Med. 1988;319:80–86.

    Article  PubMed  CAS  Google Scholar 

  68. Pouleur H, van Eyll C, Hanet C, Cheron P, Charlier AA, Rousseau MF. Long-term effects of xamoterol on left ventricular diastolic function and late remodeling: a study in patients with anterior myocardial infarction and singlevessel disease. Circulation. 1988;77:1081–1089.

    Article  PubMed  CAS  Google Scholar 

  69. Inouye I, Massie B, Loge D, Topic N, Silverstein D, Simpson P, Tubau J. Abnormal left ventricular filling: an early finding in mild to moderate systemic hypertension. Am J Cardiol. 1984;53:120–126.

    Article  PubMed  CAS  Google Scholar 

  70. Takenaka K, Dabestani A, Gardin JM, Russell D, Clark S, Allfie A, Henry WL. Pulsed Doppler echocardiographic study of left ventricular filling in dilated cardiomyopathy. Am J Cardiol. 1986;58:143–147.

    Article  PubMed  CAS  Google Scholar 

  71. Takenaka K, Dabestani A, Gardin JM, et al. Left ventricular filling in hypertrophic cardiomyopathy: a pulsed Doppler echocardiographic study. J Am Coll Cardiol. 1986;7:1263–1271.

    Article  PubMed  CAS  Google Scholar 

  72. Rokey R, Kuo LC, Zoghbi WA, Limacher MC, Quinones MA. Determination of parameters of left ventricular diastolic filling with pulsed Doppler echocardiography: comparison with cineangiography. Circulation. 1985;71:543–550.

    Article  PubMed  CAS  Google Scholar 

  73. Spirito P, Maron BJ, Bonow RO. Noninvasive assessment of left ventricular diastolic function: comparative analysis of Doppler echocardiographic and radionuclide angiographic techniques. J Am Coll Cardiol. 1986;7:518–526.

    Article  PubMed  CAS  Google Scholar 

  74. Ishida Y, Meisner JS, Tsujiola K, et al. Left ventricular filling dynamics: influence of left ventricular relaxation and left atrial pressure. Circulation. 1986;74:187–196.

    Article  PubMed  CAS  Google Scholar 

  75. Fisch C, Beller GA, DeSanctis RW, et al. ACC/AHA guidelines for the clinical application of echocardiography. Circulation. 1990;82(6):2323–2345.

    Article  Google Scholar 

  76. Soufer R, Wohlgelernter D, Vita NA, et al. Intact systolic left ventricular function in clinical Congestive Heart Failure. Am J Cardiol. 1985;55:1032–1036.

    Article  PubMed  CAS  Google Scholar 

  77. Dougherty AH, Naccarelli GV, Gray EL, Hicks CH, Goldstein RA. Congestive Heart Failure with normal systolic function.Am J Cardiol. 1984;54:778–782.

    Article  PubMed  CAS  Google Scholar 

  78. Marantz PR, Tobin JN, Wassertheil-Smoller S, et al. The relationship between left ventricular systolic function and Congestive Heart Failure diagnosed by clinical criteria. Circulation. 1988;77:607–612.

    Article  PubMed  CAS  Google Scholar 

  79. Cohn JN, Johnson G, Veterans Administration Cooperative Study Group. Heart failure with normal ejection fraction. The V-HeFT study. Circulation. 1990;81(III):48–53.

    Google Scholar 

  80. Warnowicz MA, Parker H, Cheiltin MD. Prognosis of patients with acute pulmonary edema and normal ejection fraction after acute myocardial infarction. Circulation. 1983;67(2):330–334.

    Article  PubMed  CAS  Google Scholar 

  81. Toiler GH, Stone PH, Muller JE, et al. Effects of gender and race on prognosis after myocardial infarction: adverse prognosis for women, particularly black women. J Am Coll Cardiol. 1987;9:473–482.

    Article  Google Scholar 

  82. Lee DC, Johnson RA, Bingham JB, et al. Heart failure in outpatients: a randomized trial of digoxin versus placebo. N Engl J Med. 1982;306:699–705.

    Article  PubMed  CAS  Google Scholar 

  83. Bonow RO, Rosing DR, Bacharach SL, et al. Effects of verapamil on left ventricular systolic function and diastolic filling in patients with hypertrophic cardiomyopathy. Circulation. 1981;64:787–796.

    Article  PubMed  CAS  Google Scholar 

  84. Setaro JF, Schulman DS, Black HR, LaCroix M, Zaret BL, Soufer R. Congestive Heart Failure, intact systolic function, and abnormal diastolic filling: improvement with verapamil in a placebo-controlled trial. Circulation. 1988;78:11–204.

    Google Scholar 

  85. Lorell BH, Paulus WJ, Grossman W, Wynne J, Cohn PF. Modification of abnormal left ventricular diastolic properties by nifedipine in patients with hypertrophic cardiomyopathy. Circulation. 1982;65:499–507.

    Article  PubMed  CAS  Google Scholar 

  86. Frishman WH, Skolnick AE, Strom JA. Effects of calcium entry blockade on hypertension-induced left ventricular hypertrophy. Circulation. 1989;80:151–161.

    Google Scholar 

  87. The SOLVD Investigators. Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and Congestive Heart Failure. N Engl J Med. 1991; 325:293–302.

    Article  Google Scholar 

  88. Cohn JN, Johnson G, Ziesche S, et al. A comparison of enalapril with hydralazine-isosorbide dinitrate in the treatment of chronic Congestive Heart Failure. N Engl J Med. 1991;325:303–310.

    Article  PubMed  CAS  Google Scholar 

  89. Konstam MA, Rousseau MF, Kronenberg MW, et al. Effects of the angiotensin converting enzyme inhibitor enalapril, on the long-term progression of left ventricular dysfunction in patients with heart failure. Circulation. 1992;86:431–438.

    PubMed  CAS  Google Scholar 

  90. Cohn JN, Archibald DG, Ziesche S, et al. Effect of vasodilator therapy on mortality in chronic Congestive Heart Failure. Results of a Veteran Administration Cooperative Study. N Engl J Med. 1986;314:1547–52.

    Article  PubMed  CAS  Google Scholar 

Download references

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 1994 Springer-Verlag New York, Inc.

About this chapter

Cite this chapter

Pouleur, H. (1994). Abnormalities in Cardiac Relaxation and Other Forms of Diastolic Dysfunction. In: Hosenpud, J.D., Greenberg, B.H. (eds) Congestive Heart Failure. Springer, New York, NY. https://doi.org/10.1007/978-1-4613-8315-4_5

Download citation

  • DOI: https://doi.org/10.1007/978-1-4613-8315-4_5

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4613-8317-8

  • Online ISBN: 978-1-4613-8315-4

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics