Dubois-Randé J L, Chazouillère A F, Darmon M E, Bourachot M L, Dupouy P
Service de Cardiologie, Hôpital Henri-Mondor, Créteil.
Ann Cardiol Angeiol (Paris). 1994 Dec;43(10):563-72.
Impairment of relaxation and diastole is usual if not constant in cardiomyopathies and accompanies a disorder of cardiac contractile function. Certain heart diseases, especially hypertrophic cardiomyopathy, are associated with relative preservation of contractility and the predominant disorder concerns left ventricular filling. The clinical consequence of this impairment is dyspnoea due to elevated pressures of the left-sided cavities. The loss of atrial systole atrial is usually very poorly tolerated. There is an ambiguity of definitions, as, for the clinician, diastole starts at the time of closure of the aortic valve and consists of four phases: isometric relaxation, rapid ventricular filling, diastasis and atrial systole. In reality, this definition must be reviewed in physiological terms, asthe relaxation which allows the ventricle to return to its initial precontraction configuration is an active phenomenon which is actually part of ventricular systole. The reference methods of investigation remain haemodynamic methods with invasive measurements of left ventricular pressures and volumes. Myocardial isotope scan and especially echocardiography allow assessment of relaxation and diastole, although certain limitations of interpretation must be kept in mind. In terms of treatment, the demonstration of impairment of relaxation and diastole may require a different approach when contractile function is preserved. Calcium channel blockers could be useful and the preservation of atrial systole is always decisive.
在心肌病中，舒张功能受损即使并非始终存在也是常见的，并且伴随着心脏收缩功能障碍。某些心脏病，尤其是肥厚型心肌病，与收缩功能的相对保留有关，主要的问题在于左心室充盈。这种损害的临床后果是由于左侧心腔压力升高导致的呼吸困难。心房收缩功能丧失通常耐受性很差。定义存在模糊性，因为对于临床医生来说，舒张期始于主动脉瓣关闭之时，包括四个阶段：等容舒张期、快速心室充盈期、舒张期停滞和心房收缩期。实际上，这个定义必须从生理学角度重新审视，因为使心室恢复到收缩前初始状态的舒张是一种主动现象，实际上是心室收缩期的一部分。主要的检查方法仍然是通过有创测量左心室压力和容积的血流动力学方法。心肌同位素扫描尤其是超声心动图可以评估舒张功能，尽管必须牢记某些解释上的局限性。在治疗方面，当收缩功能保留时，舒张功能受损的证明可能需要不同的方法。钙通道阻滞剂可能有用，保留心房收缩功能始终是决定性的。
