Glantz S A
Fed Proc. 1980 Feb;39(2):162-8.
Most quantitative studies of the diastolic heart have been motivated by the desire to compute an index that reflects the left ventricle's resistance to filling and relates to the mechanical properties of the muscle comprising the heart. Despite considerable effort, no consensus has developed concerning how best to describe the diastolic left ventricle. These difficulties follow from the fact that most of the indices have been ad hoc empirical descriptions of data with little or no theoretical base in the mechanics of the heart. The indices that arise from more accurate theoretical analyses are rarely tested experimentally to validate the assertion that the parameters in the theoretical models actually reflect what they claim to reflect (e.g., the elasticity of the myocardium) before applying them to clinical data. These difficulties are compounded by the fact that in a clinical setting one can only observe a short segment of the diastolic pressure-volume curve that does not provide enough information to reliably compute any of the indices of stiffness that have been proposed to date. Meanwhile, new clinical observations and animal studies have shown that the diastolic pressure-volume curve shifts following administration of drugs that appear not to alter muscle's mechanical properties. These developments suggest that future work should focus on developing theoretical models capable of explaining these phenomena, validating these theories experimentally, and discovering their physiological significance, rather than attempting to relate chamber stiffness to disease.
大多数关于舒张期心脏的定量研究都是出于这样一种愿望，即计算一个能够反映左心室充盈阻力并与构成心脏的肌肉力学特性相关的指标。尽管付出了巨大努力，但对于如何最好地描述舒张期左心室，尚未达成共识。这些困难源于这样一个事实，即大多数指标都是对数据的临时经验性描述，在心脏力学方面几乎没有或根本没有理论基础。从更精确的理论分析中得出的指标很少经过实验验证，以证实理论模型中的参数在应用于临床数据之前确实反映了它们所声称反映的内容（例如，心肌的弹性）。这些困难因以下事实而更加复杂：在临床环境中，人们只能观察到舒张期压力 - 容积曲线的一小段，这无法提供足够的信息来可靠地计算迄今为止提出的任何刚度指标。与此同时，新的临床观察和动物研究表明，在使用似乎不会改变肌肉力学特性的药物后，舒张期压力 - 容积曲线会发生变化。这些进展表明，未来的工作应侧重于开发能够解释这些现象的理论模型，通过实验验证这些理论，并发现它们的生理意义，而不是试图将心室僵硬度与疾病联系起来。
