Subscribe to RSS
DOI: 10.1055/s-0032-1332495
Impact of diastolic dysfunction on global contractile capacity on the level of the myofilaments
Objectives: Diastolic dysfunction (DD) accounts for as many as 40% of all cases of congestive heart failure (CHF). The prevalence of diastolic heart failure (DHF) in patients with normal systolic function increases with age and is significantly higher in women than in other groups: up to 75% of patients who have diastolic heart failure are women. In the progression of most cardiac diseases, diastolic dysfunction precedes systolic impairment. Because of lack of data, there are no therapeutic recommendations for treatment. Therefore we performed a study to compare the cardiac capacity of the contractile elements of patients with (Group I) and without diastolic dysfunction (Group II).
Methods: Right auricle tissue from 8 patients (4 patients per group), undergoing aortic and/or mitral valve replacement was obtained prior to right atrial cannulation. Patients in both groups are reported to have normal left ventricular function. The tissue was transported in an oxygenated Krebs-Henseleit-solution and skinned with Triton-X. The fibers were exposed to a gradual increase of calcium concentration (6 steps of calcium concentration) and the corresponding force was measured and recorded. We performed 3 experiments with different fibers in each patient (n = 48).
Results: 1. Patients with diastolic dysfunction showed statistically significant less force compared to those without diastolic dysfunction (p = 0.0002). 2.) This difference could also be found when focused on gender: female fibers from group II showed significant higher force values than fibers with the dysfunction (p = 0.0001) 3.) Also the male fibers without the diastolic dysfunction developed significant more force than male fibers without the dysfunction (p = 0.01).
Conclusions: Our data shows, that the contribution of diastolic dysfunction to the global cardiac performance is underreported and not imaged by statements about the LVF or EF. We observed a significant less force capacity in patients with diastolic disorder. This significance is even more pronounced in female fibers with and without diastolic dysfunction, but also seen in the male gender. Based on the fact that there is no standardized therapy concept regarding diastolic dysfunction further studies are required to prevent diastolic heart failure and provide patients with the best available therapy.