Circulation, Vol 83, 315-327, Copyright © 1991 by American Heart Association
ET van der Velde, D Burkhoff, P Steendijk, J Karsdon, K Sagawa and J Baan
The effects of mechanical changes in loading conditions on the left
ventricular end-systolic pressure-volume relation (ESPVR) were studied in
nine open-chest dogs, including three dogs studied before and after
beta-adrenergic blockade. Left ventricular pressure was measured with a
micromanometer, and left ventricular volume was measured with a conductance
catheter. ESPVRs were obtained by increasing left atrial inflow over wide
volume ranges (as much as threefold) under three different conditions:
control or high or low aortic impedance. High impedance was obtained by
occlusion of the descending aorta, and low impedance was obtained by a
shunt between the subclavian artery and the left atrium. In the unblocked
animals in 21 of 28 runs, a second-order polynomial equation gave a better
fit for the ESPVR than a linear relation. To quantify the effects of the
changes in aortic impedance on the ESPVR, we calculated from the quadratic
equation its volume intercept (V18) and its local slope (E18) at an
end-systolic pressure (Pes) of 18 kPa. In the unblocked animals, a
statistically significant difference was found in V18 between low impedance
(21.50 +/- 6.27 ml) and high impedance (14.10 +/- 8.98 ml; p less than
0.005) and between control (19.14 +/- 9.58 ml) and high impedance (p less
than 0.05). In most dogs, E18 was increased at high and decreased at low
impedance, but not significantly. In the additional experiments with beta-
blockade, the nonlinearity diminished somewhat, but the load dependency of
the ESPVR remained present after beta-blockade because the same leftward
shift of the ESPVR with high aortic impedance was found. Two other
relations, namely, of dP/dtmax and of stroke work versus end- diastolic
volume, were also investigated, which on the whole showed the same behavior
as the ESPVR. These results indicate that the ESPVR and dP/dtmax-Ved and
stroke work-end-diastolic volume relations, when studied over a wide volume
range, are nonlinear and that changes in loading conditions influence
indexes of contractility derived from these relations, especially the
volume intercepts, in such a way that an increase in aortic impedance may
be interpreted as an increase in contractility. Blocking the
beta-adrenergic receptors did not influence the load dependency of the
ESPVR but, in some cases, tended to decrease the nonlinearity in
concordance with the relation between contractility and nonlinearity in
isolated hearts.
ARTICLES
Nonlinearity and load sensitivity of end-systolic pressure-volume relation of canine left ventricle in vivo
Department of Cardiology, Leiden University Hospital, The Netherlands.
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