Circulation, Vol 75, 1295-1309, Copyright © 1987 by American Heart Association
JA Spratt, GS Tyson, DD Glower, JW Davis, LH Muhlbaier, CO Olsen and JS Rankin
The end-systolic pressure-volume relationship (ESPVR) has been shown to be
an afterload-insensitive descriptor of ventricular inotropic state in the
isolated heart. The purpose of this study was to examine the effects of
changes in afterload, heart rate, intravascular volume, autonomic tone, and
inotropic state on the ESPVR in conscious dogs. In 30 dogs, left
ventricular and pleural pressures were measured with micromanometers, and
left ventricular volume was assessed with global ultrasonic crystals. The
ESPVR was obtained during vena caval occlusions in each dog during
pharmacologic afterload interventions at control and after autonomic
blockade. Analysis of variance techniques were used to compare the slopes
(Emax) and intercepts (Vd) of ESPVR regression lines in a given study. All
estimates of the ESPVR in conscious dogs involved large extrapolations to
obtain estimates of Vd. Repeat determinations of Emax at control in the
unblocked state were significantly different in six of eight dogs (p less
than .05). After autonomic blockade, these differences were significant in
only one of eight dogs. Changes in heart rate and volume loading had
minimal effects on the ESPVR. In the absence of autonomic blockade,
increases in inotropic state with either calcium or dobutamine tended to
cause parallel shifts in the ESPVR. After autonomic blockade, Emax
increased with augmentation of inotropic state, while Vd was unchanged.
ESPVRs obtained at different afterloads showed statistically significant
differences in Emax and in Vd in 12 of 14 dogs. However, no statistically
significant relationship of Emax to afterload was observed. Thus, the ESPVR
is probably valid in conscious dogs, but measurement with an intact
cardiovascular system is hampered by statistically significant variability
in Emax and Vd with changes in afterload. Baseline variability is magnified
by the autonomic nervous system, probably mediated through sympathetic
reflexes.
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The end-systolic pressure-volume relationship in conscious dogs
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