Circulation, Vol 53, 293-302, Copyright © 1976 by American Heart Association
MA Quinones, WH Gaasch and JK Alexander
To determine the sensitivity of several isovolumic and ejection phase
indices of myocardial contractility to loading, inotropic stimulation and
heart rate in man, 14 patients (pts) were studied during cardiac
catheterization with simultaneous recordings of left ventricular (LV)
pressures and ultrasound dimensions. Measurements were made of
instantaneous and mean circumferential fiber shortening velocity (VCF),
maximal (max) rate of LV pressure rise (dP/dt), dPHdt divided by end-
diastolic circumference [(dP/dt)/C], (DP/dt)/C divided by aortic valve
opening pressure [(dP/dt/CP], PEAK CONTRACTILe element velocity (VCE) using
total LV pressure, VCE extrapolated to zero total pressure (Vmax), VCE at a
developed pressure of 10 mm Hg (VCEDP10) and dP/dt at a common isovolumic
developed pressure of 40 mm Hg [(dP/dt)/DP40]. Resulta are expressed in per
cent change of the mean for the group. Acute preload increase (8.6%
increase in end-diastolic circumference) with volume expansion at constant
heart rate in 7 pts produced insignificant changes in VSF, an 8.3% increase
in max dP/dt, no change in (dP/dt)/C, a variable response in (dP/dt)/CP,
18% reduction in peak VCE, 16% reduction in Vmax, 14% increase in VCEDP10,
and a 10% increase in (dP/dt)/DP40. An acute increase in afterload produced
by angiotensin in 8 pts (44% increase in peak stress) led to a 38% decrease
in VCF, a 2.5% increase in max dP/dt, no significant change in (dP/dt)/C, a
26% reduction in (dP/dt)/CP, variable responses in peak VCE and Vmax, an
11% increase in VCEDP10 and minor changes in (dP/dt)/DP40. All of the
contractility indices were augmented significantly by isoproterenol and
atrial pacing. In a given patient, max, dP/dt appears to be useful in the
assessment of acute changes in inotropic state since the magnitude of its
response to abrupt changes in preload is small and to afterload
insignificant. Normalizing max dP/dt for end-diastolic circumference
assures better stability during loading with good sensitivity to inotropic
stimulation. VCF may be used whenever changes in afterload are minimal. The
isovolumic measurements of VCE (regardless of whether total or developed
pressure is used) lack sufficient stability during acute changes in loading
conditions to warrant their use in the quantitative assessment of acute
changes in inotropic state.
ARTICLES
Influence of acute changes in preload, afterload, contractile state and heart rate on ejection and isovolumic indices of myocardial contractility in man
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