日本小児循環器学会雑誌 Pediatric Cardiology and Cardiac Surgery

Although many events in clinical pediatric cardiology require the evaluation of the pathophysiology of heart failure, accurate measurement and evaluation of diastolic function, which is an important aspect of hemodynamics, remain difficult. Ventricular diastolic function can be classified into early diastolic relaxation and late diastolic stiffness. Early ventricular diastolic relaxation is affected by the viscoelastic and restorative forces of the contracted myocardium (elastic recoil), myosin and actin inactivation of contraction (active relaxation), and preload reflected in the atrial pressure. The increase in ventricular stiffness in late diastole is related to titin isoforms and collagen production in myocardial interstitial tissues, and these factors also contribute to early diastolic elastic recoil and restoring force. This review explains the importance of understanding the pathophysiology and components of ventricular diastolic function using the concept of pressure phase plane and pressure-volume loop, in addition to the evaluation of diastolic function by echocardiography.