LV twisting and untwisting in HCM: Ejection begets filling

Conventional and emerging concepts on mechanisms by which hypertrophic cardiomyopathy (HCM) engenders diastolic dysfunction are surveyed. A shift from familiar left ventricular (LV) diastolic function approaches to large-scale (twist-untwist) and small-scale (titin unfolding-refolding, etc.) wall re...

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Bibliographic Details
Published inThe American heart journal Vol. 162; no. 5; pp. 798 - 810
Main Author Pasipoularides, Ares, MD, PhD, FACC
Format Journal Article
LanguageEnglish
Published Elsevier Inc 01.11.2011
Subjects
Cardiovascular
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Summary:Conventional and emerging concepts on mechanisms by which hypertrophic cardiomyopathy (HCM) engenders diastolic dysfunction are surveyed. A shift from familiar left ventricular (LV) diastolic function approaches to large-scale (twist-untwist) and small-scale (titin unfolding-refolding, etc.) wall rebound models, incorporating interaction and dynamic distortions and rearrangements of myofiber sheets and ultrastructural constituents, is suggested. Such an emerging new paradigm of diastolic dynamics, emphasizing the relationship of myofiber sheet and ultraconstituent distortion to LV mechanics and end-systolic shape, might clarify intricate patterns of early diastolic rebound and suction, needed for LV filling in many of the polymorphic phenotypes of HCM.
ISSN:0002-8703
1097-6744
DOI:10.1016/j.ahj.2011.08.019