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Extrinsic Versus Intrinsic Determinants of the Diastolic Pressure—Volume Relation

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Cardiac-Vascular Remodeling and Functional Interaction

Summary

The left-ventricular diastolic pressure—volume relation (LV-DPVR) is determined by intrinsic properties of the chamber as well as by forces that are external to the heart, principally resulting from pericardial and right heart loads. Intrinsic factors can be divided into passive and active components. Passive elements include myocardial viscoelasticity, caused by structural proteins within the sarcomere, extra-cellular matrix proteins, and coronary vascular turgor, and chamber geometric factors such as wall thickness, cavity shape, and filling deformation. Active components of chamber stiffness are principally related to calcium handling and neurohumoral activation. This can manifest as delayed isovolumic relaxation that influences the early portion of the LV-DPVR, or altered diastolic “tone” which influences overall chamber distensibility. Among these factors, the dominant determinants of the LV-DPVR appear to be structural, because the relation is generally unaltered by acute pharmacological or physiological manipulations. External influences on the LV-DPVR are primarily direct ventricular interaction and constraining forces from the pericardium. These external loads are more easily altered by acute interventions and likely underlie many reported upward or downward shifts in the LV-DPVR from various interventions (e.g., vasodilators, channel blockers, exercise, ischemia). External constraining forces contribute a substantial percent (≈35%) of the resting diastolic pressures in humans, and thereby play an important role in determining the net dependence of cardiac output on filling pressure. In this chapter, we review the determinants of the LV-DPVR and focus on the relative influence of intrinsic and extrinsic factors.

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Authors and Affiliations

  1. Division of Cardiology, Department of Internal Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, 21287, USA

    David A. Kass

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Editors and Affiliations

  1. First Department of Internal Medicine, Fukushima Medical College, Hikariga-oka 1, 960-12, Fukushima, Japan

    Yukio Maruyama M.D., Ph.D. (Professor and Chairman) (Professor and Chairman)

  2. First Department of Medicine, Osaka University School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565, Japan

    Masatsugu Hori M.D., Ph.D. (Chief) (Chief)

  3. College of Veterinary Medicine, Auburn University, 106 Greene Hall, 36849-5517, Auburn, AL, USA

    Joseph S. Janicki Ph.D. (Professor, Associate Dean of Research and Graduate Studies) (Professor, Associate Dean of Research and Graduate Studies)

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© 1997 Springer Japan

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Kass, D.A. (1997). Extrinsic Versus Intrinsic Determinants of the Diastolic Pressure—Volume Relation. In: Maruyama, Y., Hori, M., Janicki, J.S. (eds) Cardiac-Vascular Remodeling and Functional Interaction. Springer, Tokyo. https://doi.org/10.1007/978-4-431-67041-4_12

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  • DOI: https://doi.org/10.1007/978-4-431-67041-4_12

  • Publisher Name: Springer, Tokyo

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