Buckberg Gerald, Hoffman Julien I E, Mahajan Aman, Saleh Saleh, Coghlan Cecil
Department of Cardiothoracic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA.
Circulation. 2008 Dec 9;118(24):2571-87. doi: 10.1161/CIRCULATIONAHA.107.754424.
The keynote to understanding cardiac function is recognizing the underlying architecture responsible for the contractile mechanisms that produce the narrowing, shortening, lengthening, widening, and twisting disclosed by echocardiographic and magnetic resonance technology. Despite background knowledge of a spiral clockwise and counterclockwise arrangement of muscle fibers, issues about the exact architecture, interrelationships, and function of the different sets of muscle fibers remain to be resolved. This report (1) details observed patterns of cardiac dynamic directional and twisting motions via multiple imaging sources; (2) summarizes the deficiencies of correlations between ventricular function and known ventricular muscle architecture; (3) correlates known cardiac motions with the functional anatomy within the helical ventricular myocardial band; and (4) defines an innovative muscular systolic mechanism that challenges the previously described concept of "isovolumic relaxation." This new knowledge may open new doors to treating heart failure due to diastolic dysfunction.
理解心脏功能的关键在于认识到产生收缩机制的潜在结构，这些收缩机制导致了超声心动图和磁共振技术所揭示的心脏变窄、缩短、延长、变宽和扭转。尽管对肌纤维呈螺旋状顺时针和逆时针排列有一定的背景知识，但不同肌纤维组的确切结构、相互关系和功能等问题仍有待解决。本报告：(1) 通过多种成像源详细阐述观察到的心脏动态方向和扭转运动模式；(2) 总结心室功能与已知心室肌结构之间相关性的不足之处；(3) 将已知的心脏运动与螺旋状心室心肌带内功能解剖结构相关联；(4) 定义一种创新的肌肉收缩机制，对先前描述的 “等容舒张” 概念提出挑战。这些新知识可能为治疗舒张功能障碍引起的心力衰竭开辟新途径。
