Circulation, Vol 83, 202-212, Copyright © 1991 by American Heart Association
M Takeuchi, Y Igarashi, S Tomimoto, M Odake, T Hayashi, T Tsukamoto, K Hata, H Takaoka and H Fukuzaki
This study assessed a new method of estimating the slope (Ees) of the
end-systolic pressure-volume relation (ESPVR) from a single beat of the
human heart. Left ventricular pressure was recorded with a high- fidelity
micromanometer in patients with heart disease during left ventriculography.
Peak isovolumic pressure at the end-disastolic volume was estimated by a
curve-fitting technique from an isovolumic left ventricular pressure curve.
The ESPVR line was drawn from the estimated peak isovolumic pressure-volume
point tangential to the left upper corner of the pressure-volume loop. The
slope of this estimated ESPVR line from single-beat analysis was compared
with the slope of the ESPVR line obtained from three pressure-volume loops
in 16 patients given angiotensin II or nitroglycerin infusion. The
estimated Ees was 5.0 +/- 2.2 mm Hg/ml/m2, and the conventional Ees was 4.9
+/- 2.7 mm Hg/ml/m2. The estimated Ees showed a positive correlation with
the conventional Ees (r = 0.91, p less than 0.001, SEE = 1.2 mm Hg/ml/m2).
In the other 13 patients, after dobutamine infusion (5 micrograms/kg/min
i.v.) the estimated Ees increased significantly from 5.6 +/- 1.4 to 7.4 +/-
2.0 mm Hg/ml/m2 (p less than 0.01). Thus, the estimated Ees approximated
the conventional Ees and was sensitive to a positive inotropic
intervention. We conclude that this single-beat analysis method facilitates
assessment of the beat-by-beat ESPVR of the human heart.
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Single-beat estimation of the slope of the end-systolic pressure-volume relation in the human left ventricle
First Department of Internal Medicine, Kobe University School of Medicine, Japan.
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