Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada.
IMPART Investigator Team Canada, Saint John, New Brunswick, Canada.
Am J Physiol Heart Circ Physiol. 2020 May 1;318(5):H1139-H1158. doi: 10.1152/ajpheart.00705.2019. Epub 2020 Mar 27.
Traditionally, the evaluation of cardiac function has focused on systolic function; however, there is a growing appreciation for the contribution of diastolic function to overall cardiac health. Given the emerging interest in evaluating diastolic function in all models of heart failure, there is a need for sensitivity, accuracy, and precision in the hemodynamic assessment of diastolic function. Hemodynamics measure cardiac pressures in vivo, offering a direct assessment of diastolic function. In this review, we summarize the underlying principles of diastolic function, dividing diastole into two phases: ) relaxation and ) filling. We identify parameters used to comprehensively evaluate diastolic function by hemodynamics, clarify how each parameter is obtained, and consider the advantages and limitations associated with each measure. We provide a summary of the sensitivity of each diastolic parameter to loading conditions. Furthermore, we discuss differences that can occur in the accuracy of diastolic and systolic indices when generated by automated software compared with custom software analysis and the magnitude each parameter is influenced during inspiration with healthy breathing and a mild breathing load, commonly expected in heart failure. Finally, we identify key variables to control (e.g., body temperature, anesthetic, sampling rate) when collecting hemodynamic data. This review provides fundamental knowledge for users to succeed in troubleshooting and guidelines for evaluating diastolic function by hemodynamics in experimental models of heart failure.
传统上，心脏功能的评估侧重于收缩功能；然而，人们越来越认识到舒张功能对整体心脏健康的贡献。鉴于人们对心力衰竭所有模型中舒张功能评估的兴趣日益浓厚，因此需要在评估舒张功能的血流动力学方面具有敏感性、准确性和精密度。血流动力学在体内测量心脏压力，提供对舒张功能的直接评估。在这篇综述中，我们总结了舒张功能的基本原理，将舒张分为两个阶段：)松弛和)充盈。我们确定了用于通过血流动力学全面评估舒张功能的参数，阐明了如何获得每个参数，并考虑了每个测量方法的优点和局限性。我们总结了每个舒张参数对负荷条件的敏感性。此外，我们讨论了当与自动软件生成的舒张和收缩指数相比时，在由定制软件分析生成时可能会出现的差异，以及在健康呼吸和轻度呼吸负荷期间每个参数受到的影响程度，这些在心力衰竭中很常见。最后，我们确定了在收集血流动力学数据时需要控制的关键变量（例如，体温、麻醉、采样率）。本综述为用户提供了成功解决问题的基本知识，并为心力衰竭实验模型中通过血流动力学评估舒张功能提供了指导。
