ABSTRACT
Claude Lenfant, when Director of the National Heart Lung and Blood Institute, issued an inspirational challenge to those who, like the authors, are firm believers in ‘integrative physiology’ and who fear that attention to fine detail has detracted attention from the ‘big picture’. Nowhere is this more relevant than to the issue of ventricular-vascular interaction. This issue is of supreme importance in the study of cardiac function and cardiac failure. However, the issue was virtually ignored in the report of the Task Force on Research in Heart Failure, presented by Dr Lenfant at the National Heart, Lung and Blood Institute (NHLBI) conference in 1994 (Lenfant,
1994; Lenfant, 1995) and in more recent reports of the NHLBI (Cohn et al., 1997). A new updated report is expected to be published under editorship of Suzanne Oparil in early 2012. In recent issues of the Journal of American College of Cardiology, new approaches are foreshadowed (Nabel and Lauer, 2009) by the NHLBI, but these appear to emphasize narrow new technology related to myocardial subcellular processes. In contrast, cardiac load, described as impedance, is considered synonymous with peripheral resistance, and no account is taken of the gross changes in arterial stiffness and wave reflection that add to resistive hydraulic load in aging humans with cardiac failure (Meredith et al., 2008; Mullens et al., 2008; Yancy, 2008; O’Rourke and Nichols, 2009a; O’Rourke, 2010). The broad topic of ventricular-vascular interaction was not perceived as important to present problems or future research funding 15 years ago. This subject (aging, vascular stiffness, and cardiovascular function) was, however, identified as a priority area for research funding (NIH Guide 24: 24, 30 June 1995), and is emphasized by the most recent work from Framingham and Boston, Mayo Clinic, Wake Forest, Johns Hopkins, and elsewhere on cardiac failure in older people (Borlaug et al., 2010; Chirinos and Segers, 2010a; Chirinos and Segers, 2010b; Derval and Jais, 2010; Maeder et al., 2010; Marwick and Grimm, 2010; Paulus, 2010; Solomon et al., 2010; Spragg et al., 2010; Van Bommel et al., 2010) (see Chapter 15).
