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European Heart Journal 1990 11(Supplement G):54-64; doi:10.1093/eurheartj/11.suppl_G.54
Copyright © 1990 by the European Society of Cardiology.
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© 1990 The European Society of Cardiology

Diastolic function in left ventricular hypertrophy: Clinical and experimental relationships

B. H. Lorell*, C. S. Apstein, E. O. Weinberg and M. J. Cunningham*

Cardiac Muscle Research Laboratory, Cardiovascular Institute, Boston University School of Medicine, and the Cardiology Section of the Thorndike Memorial Laboratory, Boston City Hospital Boston, Massachusetts, U.S.A.
* Charles A. Dana Research Institute and the Harvard Thorndike Laboratories, Beth Israel Hospital and the Department of Medicine (Cardiovascular Division), Beth Israel Hospital Boston, Massachusetts, U.S.A.

Address for correspondence: Beverly H. Lorell MD, Associate Professor of Medicine, Cardiovascular Division, Beth Israel Hospital, 330 Brookline Avenue, Boston, MA 02215, U.S.A.

The evaluation of patients with left ventricular hypertrophy and the clinical syndrome of congestive heart failure requires the ability to distinguish between the etiologia of abnormal systolic contractile function and abnormalities of diastolic relaxation and filling. In patients with left ventricular hypertrophy and congestive heart failure, predominant diastolic dysfunction should be suspected when elevation of left ventricular diastolic pressure is detected in the presence of normal diastolic chamber volume or dimensions and preserved systolic shortening. The mechanisms which account for diastolic dysfunction in the presence of cardiac hypertrophy are controversial and are likely to be multiple. These mechanisms may include changes in left ventricular geometry, per se, changes in the composition of the left ventricular wall (fibrosis or alteration in collagen), and dynamic factors which modulate diastolic force inactivation (loading conditions, cytosolic calcium handling, cyclic AMP availability). In addition, recent studies suggest that hypertrophied cardiac muscle may be particularly susceptible to develop diastolic dysfunction in response to the stress of hypoxia or ischaemia.

Key Words: Diastole • hypertrophy • ischaemia • heart failure


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