Nishimura R A, Housmans P R, Hatle L K, Tajik A J
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905.
Mayo Clin Proc. 1989 Jan;64(1):71-81. doi: 10.1016/s0025-6196(12)65305-1.
In the past, evaluation of the myocardium has been limited to examining systolic function of the heart. Recently, however, investigators have demonstrated that abnormalities of diastolic function of the heart provide important contributions to the signs and symptoms experienced by patients with heart disease. In addition, abnormalities of diastolic function may precede abnormalities of systolic function in the early stages of disease. Diastolic filling of the heart, however, is a complex sequence of interrelated events. In order to understand diastolic function, each of these factors contributing to filling of the heart must be examined. They include relaxation, passive compliance, atrial contraction, erectile effect of the coronary arteries, viscoelastic properties, ventricular interaction, and pericardial restraint--all of which are interrelated. In addition, diastolic factors are affected by changes in loading conditions and contractility, and they demonstrate nonuniformity in time and space. This report provides an overview of these various factors from the clinical perspective, based on studies involving the isolated papillary muscle and the isolated heart as well as basic clinical studies.
过去，对心肌的评估仅限于检查心脏的收缩功能。然而，最近研究人员已证明，心脏舒张功能异常对心脏病患者所经历的体征和症状有重要影响。此外，在疾病早期，舒张功能异常可能先于收缩功能异常出现。然而，心脏的舒张期充盈是一系列相互关联的复杂事件。为了理解舒张功能，必须检查每一个有助于心脏充盈的因素。这些因素包括舒张、被动顺应性、心房收缩、冠状动脉的舒张作用、粘弹性、心室相互作用以及心包限制——所有这些都是相互关联的。此外，舒张因素受负荷条件和收缩性变化的影响，并且在时间和空间上表现出不均匀性。本报告基于对离体乳头肌和离体心脏的研究以及基础临床研究，从临床角度对这些不同因素进行概述。
