Mechanical pathophysiology of some heart diseases: a theoretical model study
Tóm tắt
Sarcomere dynamics are related to the global left ventricular (LV) function in some representative pathological states, by using a theoretical model which combines sarcomere function, LV fibrous structure and geometry with the haemodynamic loading conditions. The analysis shows that pressure (concentric) hypertrophy due to hypertension or aortic stenosis is associated with an increase of the normal endocardial-to-epicardial gradient(s) of oxygen demand, which may be one of the causes for the development of endocardial fibrosis. The analysis also indicates that sarcomere shortening is relatively normal in compensated volume (eccentric) hypertrophy. Mitral stenosis demonstrates a case of decreased LV function, secondary to a chronic decrease in LV end diastolic volume, with sarcomeres that operate at their lowest length range. Conversely, the sarcomere function is depressed in cardiomyopathy; the heart's pumping function is maintained by appropriate adjustment mechanisms. However, the sarcomeres show minimal shortening and function at their highest length range with low (or zero) functional reserve. The study thus provides a quantitative tool that relates global LV function to local sarcomere dynamics in various pathological states.
Tài liệu tham khảo
Bache, R. I., Wang, Y. andGreenfield, J. C. Jr., (1973) Left ventricular ejection time in valvular aortic stenosis.Circ.,47, 527–533.
Beyar, R. andSideman, S. (1984) Computer study of the left ventricular performance based on its structure, sarcomere dynamics and electrical activation propagation.Circ. Res.,55, 358–374.
Beyar, R. andSideman, S. (1985) A mathematical approach to interrelation between the coronary blood flow and the metabolic demands. InSimulation and imaging of the cardiac system.Sideman, S. andBeyar, R. (Eds.), Martinus Nijhoff, 332–357.
Beyar, R. andSideman, S. (1986a) Left ventricular mechanics related to the local distribution of oxygen demand throughout the wall.Circ. Res.,58, 669–677.
Beyar, R. andSideman, S. (1986b) Spatial energy balance within a structural model of the left ventricle.Ann. Biomed. Eng.,14, 467–487.
Bonow, R. O., Rosing, D. R., Kent, K. M. andEpstein, S. E. (1982) The timing of operation for chronic aortic regurgitation.Am. J. Cardiol.,50, 325–336.
Braunwald, E. (1983) The cardiomyopathies and myocardities. InHeart disease: a textbook of cardiovascular medicine, 2nd edn.Braunwald, E. (Ed.), Saunders, Chap. 41.
Carabelo, B. A., Green, L. A., Grossman, W., Cohn, L. H., Kosten, J. K. andCollins, J. J. (1980) Hemodynamic determinants of prognosis of aortic valve replacement in critical aortic stenosis in advanced congestive heart failure.Circ.,62, 42–44.
Caspari, P. G., Newcomb, M., Gibbson, K. andHarris, P. (1977) Collagen content in the normal and hypertrophied human ventricle.Cardiovasc. Res.,11, 554–558.
Feigl, E. O. (1983) Coronary physiology.Physiol. Rev.,63, 1–205.
Feit, T. S. (1979) Diastolic pressure volume relationship and distribution of pressure and fiber extension across the wall of a model left ventricle.Biophys. J.,28, 143–166.
Gaasch, A. K., Carabelo, B. A., Cepin, O. andSpann, J. F. (1983) Left ventricular ejection performance and systolic muscle function in patients with mitral stenosis.Circ.,67, 148–154.
Gamble, W. G., LaFarge, C. G., Fuler, D. C., Seisal, J. andMonroe, R. G. (1974) Regional coronary venous oxygen saturation and myocardial oxygen tension following abrupt changes in ventricular pressure in the isolated dog heart.Circ. Res.,34, 672–681.
Gault, J. H., Covell, J. W., Braunwald, E. andRoss, J. Jr. (1970) Left ventricular performance following correction of free aortic regurgitation.Circ.,42, 773–780.
Hatle, L. (1981) Noninvasive assessment and differentiation of left ventricular outflow obstruction with Doppler ultrasound. ——Ibid.,69, 381–387.
Hoffman, J. I. E. (1978) Determinants and prediction of transmural myocardial perfusion. ——Ibid.,58, 381–391.
Holtzer, J. A., Karliner, J. S., O'Rourke, R. A. andPeterson, K. L. (1973) Quantitative angiographic analysis of the left ventricle in patients with isolated rheumatic mitral stenosis.Br. Heart J.,35, 497–502.
Ingels, N. G., Daughters, G. T., Stinson, E. D. andAlderman, E. C. (1975) Measurements of midwall myocardial dynamics in intact man by radiography surgically implanted markers.Circ.,52, 859–867.
Kligfield, P., Okin, P., Richard, B., Devereux, B., Goldberg, H. andBorer, J. S. (1984) Duration of ejection in aortic stenosis: effect of stroke volume and pressure gradient.J. Am. Coll. Cardiol.,3, 157–161.
Krueger, W. andPollack, G. H. (1975) Myocardial sarcomere dynamics during isometric contraction.J. Physiol. (Lond.),251, 627–638.
Lima, O. C., Sahn, D. J., Valdes Cruz, I. M., Goldberg, S. L., Barron, J. V., Allen, H. D. andGrenadier, E. (1983) Noninvasive prediction of transvalvular pressure gradient in patients with pulmonary stenosis by quantitative two dimensional echocardiographic Doppler studies.Circ.,67, 866–871.
Marcus, M. I., Mueller, T. M., Gascho, J. A. andKerber, R. E. (1979) Effects of cardiac hypertrophy secondary to hypertension on the coronary circulation.Am. J. Cardiol.,44, 1023–1028.
Mirsky, I., Malkenson, L. andVatner, S. F. (1983) Left ventricular function in pressure overload hypertrophy at rest and in response to catecholamine stress.Circ.,68, Suppl. III, 303.
Mirsky, I., Pfeffer, J. M., Pfeffer, M. A. andBraunwald, E. (1984) The contractile state as the major determinant in the evolution of left ventricular dysfunction in the spontaneous hypertensive rat.Circ. Res.,53, 767–778.
Nicholas, A., Sciacca, R. R., Weiss, M. B., Blood, D. K., Brennan, D. L. andCannon, P. J. (1980) Effect of left ventricular hypertrophy on myocardial blood flow and ventricular performance in systemic hypertension.Circ.,62, 329–340.
O'Rourke, R. A. andCrawford, M. H. (1980) Timing of valve replacement in patients with chronic aortic regurgitation (Editorial). ——Ibid.,61, 493–495.
Rahimtoola, S. H. (1977) Early valve replacement for preservation of ventricular function (Editorial).Am. J. Cardiol.,40, 471–475.
Rakusan, K. (1971) Quantitative morphology of capillaries of the heart: number of capillaries in animal and human hearts under normal and pathological conditions.Methods Archiev. Exp. Pathol.,5, 272–286.
Schwartz, E., Mall, G., Zebe, H., Schmitzer, E., Manthey, J., Schuerlen, H. andKubler, W. (1984) Determinants of survival in patients with congestive cardiomyopathy: quantitative morphologic findings and LV hemodynamics.Circ.,70, 923–928.
Sonnenblick, E. H., Ross, J., Covel, H. W., Spotnitz, N. M. andSpiro, D. (1967) The ultrastructure of the heart in systole and diastole.Circ. Res.,21, 423–431.
Sonnenblick, E. H., Skelton, C. L., Spotnitz, W. D. andFellman, D. (1973) Redefinition of the ultrastructural basis of cardiac length-tension relations.Circ.,48, 65–72.
Sonnenblick, E. H. (1980) The structural basis and importance of restoring forces and elastic record of the filling of the heart.Europ. Heart J.,1, (Suppl. A), 107–110.
Straurer, B. E. (1979) Myocardial oxygen consumption in chronic heart disease, role of wall stress hypertrophy and coronary reserve.Am. J. Cardiol.,44, 730–740.
Streeter, D. P., Spontiz, H. M., Patel, D. J., Ross, J. andSonnenblick, E. H. (1969) Fiber orientation in the canine left ventricle during diastole and systole.Circ. Res.,24, 339–347.
Sutton, M. G. St. J., Plappent, T. A., Hirshfeld, J. W., andReichek, N. (1984) Assessment of left ventricular mechanics in patients with asymptomatic aortic regurgitation: a two-dimensional echochardiographic study.Circ.,69, 259–268.
Taylor, R. R. andHopkins, B. E. (1972) Left ventricular response to experimentally induced chronic regurgitation.Cardiovasc. Res.,6, 404–414.
Weiss, M. B., Ellis, K., Sciacca, R. R., Johnson, L. L., Schmit, D. M. andCannon, P. J. (1976) Myocardial blood flow in congestive and hypertrophic cardiomyopathy relation to peak wall stress and mean velocity of circumferential fiber shortening.Circ.,54, 484–494.
Weiss, H. R., Neubauer, J. A., Lipp, J. A. andSinha, A. K. (1978) Quantitative determination of regional oxygen consumption in the dog heart.Circ. Res.,43, 394–401.
Wynne, J. andBraunwald, E. (1984) The cardiomyopathies and myocardities. InPrinciples of internal medicine.Harrison, T. R. (Ed.), McGraw-Hill, 1449.