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Departments of 1 Cardiology and 2 Pediatrics (Pediatric Cardiology), Leiden University Medical Center, 2300 RC Leiden; and 3 Department of Pediatric Cardiology, Erasmus Medical Center-Sophia Children's Hospital, 3000 CB Rotterdam, The Netherlands
Diastolic function is a major
determinant of ventricular performance, especially when loading
conditions are altered. We evaluated biventricular diastolic function
in lambs and studied possible load dependence of diastolic parameters
[minimum first derivative of pressure vs. time
(dP/dtmin) and time constant of isovolumic relaxation (
)] in normal (n = 5) and chronic right
ventricular (RV) pressure-overloaded (n = 5) hearts by
using an adjustable band on the pulmonary artery (PAB). Pressure-volume
relations were measured during preload reduction to obtain the
end-diastolic pressure-volume relationship (EDPVR). In normal lambs,
absolute dP/dtmin and were lower in the RV
than in the left ventricle whereas the chamber stiffness constant
(b) was roughly the same. After PAB, RV and
dP/dtmin were significantly higher compared with
control. The RV EDPVR indicated impaired diastolic function. During
acute pressure reduction, both dP/dtmin and showed a relationship with end-systolic pressure. These relationships
could explain the increased dP/dtmin but not the
increased -value after banding. Therefore, the increased after
banding reflects intrinsic myocardial changes. We conclude that after
chronic RV pressure overload, RV early relaxation is prolonged and
diastolic stiffness is increased, both indicative of impaired diastolic function.
hemodynamics; hypertrophy; pressure-volume relation; ventricular function, diastole
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