Kuhtz-Buschbeck Johann-Peter, Lie Reidar K, Schaefer Jochen, Wilder Nicolaus
Perspect Biol Med. 2016;59(4):471-490. doi: 10.1353/pbm.2016.0042.
This article explores the importance of diagrams in the history of the understanding of cardiac function, by comparing Ernest Starling's famous "Law of the Heart" (1918) with the mathematically based view of cardiac mechanics put forward by Otto Frank (1897). Whereas Frank's diagrams gained influence in German cardio-physiological publications, they were widely unknown abroad until 1969, when Hiroyuki Suga began to present similar approaches for warm-blooded animals as Frank had done for the frog. Suga succeeded in correlating the pressure volume area (PVA)-a composite of Frank's work loop plus the area of remaining potential energy-with the oxygen consumption of the beating heart. With the concept of time-varying elastance as an index of cardiac contractility, Suga's approach became attractive for clinical applications, and Daniel Burkhoff and colleagues were able to use these insights for real-time, interactive simulations of the cardiovascular system. Such tools can be used for exploring basic hemodynamic principles and, thanks to technical developments of miniature pumps within the same time frame (Καιρός, the "right moment," or "the opportune"), to test the effects of device-based treatment for heart failure. These outcomes confirm that old analyses of the heart's activity may still be useful today.
本文通过将欧内斯特·斯塔林著名的“心脏定律”（1918年）与奥托·弗兰克（1897年）提出的基于数学的心脏力学观点进行比较，探讨了图表在心脏功能理解史上的重要性。虽然弗兰克的图表在德国心脏生理学出版物中产生了影响，但直到1969年它们在国外还鲜为人知，当时菅幸之开始像弗兰克对青蛙所做的那样，为温血动物提出类似的方法。菅幸之成功地将压力容积面积（PVA）——弗兰克工作环的一个综合指标加上剩余势能的面积——与跳动心脏的氧消耗联系起来。随着时变弹性概念作为心脏收缩性的指标，菅幸之的方法在临床应用中变得具有吸引力，丹尼尔·伯克霍夫及其同事能够将这些见解用于心血管系统的实时交互式模拟。这样的工具可用于探索基本的血液动力学原理，并且由于在同一时期微型泵的技术发展（Καιρός，“正确的时刻”或“合适的时机”），可以测试基于设备的心力衰竭治疗效果。这些结果证实，对心脏活动的旧有分析在今天可能仍然有用。
