Circulation, Vol 74, 991-1001, Copyright © 1986 by American Heart Association
A Pasipoularides, I Mirsky, OM Hess, J Grimm and HP Krayenbuehl
We have developed a model for assessing the influence of the decaying
contractile systolic tension on diastolic wall dynamics and the passive
properties of left ventricular muscle. Total measured left ventricular
diastolic pressure and stress (sigma T) are determined by two overlapping
processes: the decay of actively developed pressure and stress (sigma A)
and the buildup of passive filling pressure and stress (sigma*). The
decaying contractile stress sigma A is formulated in terms of a relaxation
pressure with a time constant (T) assessed during the isovolumic relaxation
interval. By subtracting the contribution of sigma A from sigma T we obtain
sigma*. With micromanometry, echocardiography, and cineangiography, total
and passive stress-strain relations and strain rates were evaluated over
the entire filling period in six normal control subjects and in seven
patients with aortic stenosis. Elastic stiffness constants (k), the slopes
of the linear passive stiffness vs sigma* relations, did not differ in the
two groups over a common lower stress range (6/6 normal, k = 9.37 +/- 1.23;
7/7 aortic stenosis, k = 9.34 +/- 1.08). Over a higher sigma* range,
transition into a much steeper linear region occurred, and k values were
much larger (4/7 aortic stenosis, k = 28.76 +/- 2.02). When diastolic
stress levels are elevated, passive stiffness-stress relations can be
better described as bilinear, with a much greater wall stiffness constant
in the higher than in the lower stress range. Dynamic effects of decaying
systolic contractile wall stress components are important in the rapid
filling phase in normal hearts as well as in those with aortic stenosis.
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