Historical perspective on heart function: the Frank–Starling Law

Abstract

More than a century of research on the FrankStarling Law has significantly advanced our knowledge about the working heart. The Frank-Starling Law mandates that the heart is able to match cardiac ejection to the dynamic changes occurring in ventricular filling and thereby regulates ventricular contraction and ejection. Significant efforts have been attempted to identify a common fundamental basis for the Frank-Starling heart and, although a unifying idea has still to come forth, there is mounting evidence of a direct relationship between length changes in individual constituents (cardiomyocytes) and their sensitivity to Ca 2+ ions. As the Frank-Starling Law is a vital event for the healthy heart, it is of utmost importance to understand its mechanical basis in order to optimize and organize therapeutic strategies to rescue the failing human heart. The present review is a historic perspective on cardiac muscle function. We Brevive^a century of scientific research on the heart's fundamental protein constituents (contractile proteins), to their assemblies in the muscle (the sarcomeres), culminating in a thorough overview of the several synergistically events that compose the Frank-Starling mechanism. It is the authors' personal beliefs that much can be gained by understanding the Frank-Starling relationship at the cellular and whole organ level, so that we can finally, in this century, tackle the pathophysiologic mechanisms underlying heart failure.

Mechanisms of high heart rate variability: a fresh look

“…Our heart contains its own "builtin" mechanism capable of automatically pumping the required amount of blood to the right atrium from the veins. It is the well-known Frank-Starling mechanism (also referred to as the Frank-Starling law) [13][14][15][16]. According to the Frank-Starling law, an increase in the blood amount supplied to the heart stretches the ventricles, and, in its turn, it increases the force of contractions, so that a greater volume of blood, as compared with the previous condition, leaves the heart for greater circulation.…”

Haemodynamic Effects of Anaemia in Patients with Acute Decompensated Heart Failure

“…In order to enable timely patient-tailored treatment of acute decompensated HF (ADHF), the evaluation process of harmful haemodynamic effects of anaemia should be simple and fast. Our previous experience with impedance cardiography (ICG) [8,9], a simple method of noninvasive haemodynamic assessment, encouraged us to verify its usefulness in such clinical settings.…”

Blood flow specific assessment of ventricular function: Visualization and quantification using 4D flow CMR

“…Each myofibril is further composed of sarcomeres arranged in series. The sarcomere is the basic contractile unit of the myocyte, measuring approximately 1.8 to 2.2 !m in physiological conditions and is limited on either side by the Z-lines (Figure 3) (15). The sarcomere itself contains the myofilaments, actin and myosin.…”

“…As the titin spring retracts during systole it enhances the ventricular contraction. This elastic restoring force is thus present whenever the myocardium stretches or contracts out of its resting equilibrium, and may explain some of the elastic characteristics of the cardiac muscle (15).…”

“…the heart pumps what it receives! The Frank-Starling mechanism is important for regulation of ventricular function and for balancing the output of the two ventricles (15). In the pressure-volume loop, an increase in venous return and ventricular filling (preload) occurs along the EDPVR line, leading to higher EDV and a widening of the pressure volume loop, increasing the SV.…”