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Eur J Cardiothorac Surg 2004;26:662-663
© 2004 Elsevier Science NL

Letter to the Editor

Systolic ventricular filling

Experimentelle Thorax-, Herz- und Gefäßchirurgie, Domagkstr. 11, 48129 Münster, Germany

Received 6 April 2004; accepted 18 May 2004.

^* Tel.: +49-251-8356256; fax: +49-251-8356257
e-mail: redmann{at}uni-muenster.de

Key Words: Band-structure • Longitudinal transmission • Stress excitation

I am deeply concerned regarding the publication of the review on the ‘systolic ventricular filling’ by Dr Torrent-Guasp and colleagues [1].

The concept of ventricular function advanced by Torrent-Guasp [1] is no more than a re-statement of the systolic descent of the mitral valve described 1936 by Böhme [2] i.e. the gliding of the subendocardial layers of ventricular musculature in the direction of the apex. Since the valve is closed, this descent of the valvar plane contributes to ventricular emptying and to atrial replenishment. As explained by Henein and Gibson [3], the subsequent fast ascent of the valvar plane is essentially driven by forces engendered in the atrial wall.

Having inappropriately interpreted the work of Brutsaert [4], Torrent-Guasp and colleagues [1] become trapped into interpreting the delayed shortening activity as a typical behaviour of the ‘ascending limb’ of the purported apical loop of their ventricular band.

According to the work of Brusaert [4], prolonged persistence of shortening typically occurs when muscle fibres are hindered in their ability to shorten, or when they are fighting against stronger muscular structures which contract in directions malaligned in relation to the weaker compartments. Therefore, prolonged shortening is function of the history of loading of any contractile unit. Any delayed onset of activity of the putative ascending limb receives no mention in the work of Brutsaert [4]. It is based on Torrent-Guasp's spurious assumption that excitation follows the hypothetical helical ‘band’ an idea which flies in the face of the known function of the ventricular conduction system.

Using needle force probes, our group has established the topography of the local generation of force [5]. There is no such late systolic onset of contraction all over the left and right ventricle as proposed by Torrent-Guasp and associates [1] nor a sequential contraction along a structure which resembles their purported ‘ventricular myocardial band’. There is, however, an unequivocal late persistence in contractile activity, which is spread heterogeneously throughout the ventricular wall [5].

Furthermore, the putative mechanism proposed by Torrent-Guasp [1], by which contraction of the purported ‘ascending segment’ should be able to induce global ventricular suction once the rest of the myocardium has ceased its contraction, remains incomprehensible. No evidence is provided to substantiate the putative self-erecting properties delegated to ventricular wall. The mechanism shown in Fig. 4 is a cartoon illustrating a concept that cannot work because the necessary gliding of the purported descending and ascending segments relative to each other is prevented by the myriads of intruding myocardial fibres, fibres that are destroyed by the artefactual techniques used by Torrent-Guasp to display his ‘ventricular myocardial band’.

All these objections that I state in this letter have been discussed in detail by me personally with Dr Torrent-Guasp. I conclude that Dr Torrent-Guasp is steadfastly impervious to any detailed criticism of his hypothesis. Your readers, however, should be aware that the hypothesis is uncontrolled, lacking experimental validation, and based instead on ‘paper’ research. In many details Dr Torrent-Guasp and his colleagues [1] choose to interpret the published literature to support their hypothesis, rather than as described by the original authors.

References

1. Torrent-Guasp F., Kociaca M.J., Corno A., Komeda M., Cox J., Flotats A., Ballester-Rodes M., Carreras-Costa F. Systolic ventricular filling. Eur J Cardio-Thorac Surg 2004;25:376-386.[Abstract/Free Full Text]
2. Böhme W. Über den aktiven Anteil des Herzens and der Förderung des Venenblutes. Ergebn Physiol 1936;38:252-338.
3. Henein M.J., Gibson D.G. Long-axis function in disease. Heart 1999;81:229-231.[Free Full Text]
4. Brutsaert D.L., Sys S.U. Relaxation and diastole of the heart. Physiol Rev 1989;69:1228-1315.[Abstract/Free Full Text]
5. Lunkenheimer P.P., Redmann K., Florek J., Fassnacht U., Cryer C.W., Wübbeling F., Niederer P., Anderson R.H. The forces generated within the musculature of the left ventricular wall. Heart 2004;90:200-207.[Abstract/Free Full Text]

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