What global diastolic function is, what it is not, and how to measure it

American Journal of Physiology. Heart and Circulatory Physiology
Charles S ChungSándor J Kovács

Abstract

Despite Leonardo da Vinci's observation (circa 1511) that "the atria or filling chambers contract together while the pumping chambers or ventricles are relaxing and vice versa," the dynamics of four-chamber heart function, and of diastolic function (DF) in particular, are not generally appreciated. We view DF from a global perspective, while characterizing it in terms of causality and clinical relevance. Our models derive from the insight that global DF is ultimately a result of forces generated by elastic recoil, modulated by cross-bridge relaxation, and load. The interaction between recoil and relaxation results in physical wall motion that generates pressure gradients that drive fluid flow, while epicardial wall motion is constrained by the pericardial sac. Traditional DF indexes (τ, E/E', etc.) are not derived from causal mechanisms and are interpreted as approximating either stiffness or relaxation, but not both, thereby limiting the accuracy of DF quantification. Our derived kinematic models of isovolumic relaxation and suction-initiated filling are extensively validated, quantify the balance between stiffness and relaxation, and provide novel mechanistic physiological insight. For example, causality-based modeling provid...Continue Reading

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Citations

Jun 18, 2017·Pulmonary Circulation·Yasunobu HayabuchiShoji Kagami
Mar 4, 2017·Scientific Reports·Elira MaksutiMartin Ugander
Jul 9, 2016·Circulation Research·Alaa Mabrouk Salem OmarPartho P Sengupta
Sep 29, 2018·American Journal of Physiology. Heart and Circulatory Physiology·Pia SjöbergMarcus Carlsson
Aug 2, 2017·Experimental Physiology·Sophie LalandeCharles S Chung
Nov 12, 2017·American Journal of Physiology. Heart and Circulatory Physiology·Sara MagnaniAntonio Crisafulli
Apr 17, 2020·Frontiers in Physiology·William W Muir, Robert L Hamlin
Apr 23, 2020·Heart Failure Reviews·Alfred StanleyGerald Buckberg
Mar 7, 2020·American Journal of Physiology. Heart and Circulatory Physiology·Druv BhagavanSándor J Kovács
Nov 14, 2020·American Journal of Physiology. Heart and Circulatory Physiology·Junedh M AmruteSándor J Kovács
May 11, 2021·Frontiers in Physiology·Sara MagnaniAntonio Crisafulli
Aug 23, 2021·The Journal of Thoracic and Cardiovascular Surgery·William M DeCampli
Dec 11, 2021·Journal of the American Heart Association·Fabrizio VallelongaGianni Pedrizzetti

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