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Linksventrikuläre diastolische Dysfunktion

Bedeutung in Anästhesie und Intensivmedizin

Left ventricular diastolic dysfunction

Implications for anesthesia and critical care

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Zusammenfassung

In den letzten beiden Dekaden wurde zunehmend erkannt, dass die Ventrikelfunktion nicht nur durch die systolische, sondern entscheidend auch durch die diastolische Funktion bestimmt wird. Eine normale diastolische Funktion ist durch die Fähigkeit gekennzeichnet, bei normalen Füllungsdrücken ausreichende Blutvolumina in die Ventrikel aufzunehmen. Bestimmt wird die diastolische Funktion durch einen aktiven, energieverbrauchenden Prozess, die Relaxation, und durch die passiven Eigenschaften des Ventrikels, die ventrikuläre Compliance. Diagnostisch nimmt die Dopplerechokadiographie durch Analyse des transmitralen sowie des pulmonalvenösen Flussprofils und durch Quantifizierung der Exkursionen des Mitralklappenanulus eine zentrale Stellung ein. In letzter Zeit wird die Bedeutung der diastolischen Ventrikelfunktion auch im perioperativen Bereich zunehmend erkannt. Neuere Studien haben gezeigt, dass es nach kardiopulmonalem Bypass zu einer Abnahme der ventrikulären Compliance kommt. Im Zusammenhang mit einer Sepsis scheinen nicht nur Störungen der aktiven Relaxation, sondern auch Veränderungen der passiven Eigenschaften des linken Ventrikels aufzutreten. Erste Arbeiten beschäftigen sich auch mit Therapieansätzen bei Patienten mit isolierter diastolischer Dysfunktion.

Abstract

Over the last two decades there has been a growing recognition that cardiac function is not solely determined by systolic but also essentially by diastolic function. Left ventricular diastolic dysfunction is characterized by an impairment of ventricular filling caused either by abnormal relaxation, an active energy consuming process or decreased compliance, which is determined by passive tissue properties of the ventricle. Doppler echocardiography, including tissue Doppler imaging, has emerged as the preferred clinical tool for the assessment of left ventricular diastolic function. Recently the importance of left ventricular diastolic function is increasingly being recognized also during the perioperative period. Newer studies have shown that after cardiopulmonary bypass there is a significant decrease in left ventricular compliance. Experimental studies have demonstrated that sepsis is associated with a decrease in both active relaxation and ventricular compliance. Initial studies are also focusing on therapeutic options for patients with isolated diastolic dysfunction.

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  1. Klinik für Anästhesiologie, Universitätsklinikum Ulm, Steinhövelstr. 9, 89075, Ulm, Deutschland

    R. Meierhenrich, W. Schütz & A. Gauss

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  1. R. Meierhenrich
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Meierhenrich, R., Schütz, W. & Gauss, A. Linksventrikuläre diastolische Dysfunktion. Anaesthesist 57, 1053–1068 (2008). https://doi.org/10.1007/s00101-008-1457-0

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