Circulation, Vol 65, 988-997, Copyright © 1982 by American Heart Association
KM Borow, A Neumann and J Wynne
The value for the slope of the left ventricular (LV) end-systolic
pressure-dimension and pressure-volume relations has been proposed as a
quantitative measure of the LV inotropic state. This measure of LV
inotropic state is attractive because it is independent of preload and
incorporates afterload. To investigate the sensitivity of the slope of
these relations to alterations in contractile state, 10 normal subjects
were studied using M-mode echocardiographic, phonocardiographic and
indirect carotid pulse recordings during infusion of methoxamine to alter
end-systolic pressure and during infusion of dobutamine (5
micrograms/kg/min) to increase LV inotropic state. Heart rate was
maintained within a narrow range for each subject. End-systolic volume was
calculated from end-systolic echocardiographic dimension by standard
methods. End-systolic pressure was estimated from the dicrotic notch
pressure determined from a calibrated carotid pulse recording; peak
systolic pressure was also measured. Regardless of the method of
approximating end-systolic pressure, the positive inotropic intervention
caused a leftward shift in the end-systolic pressure- dimension and
pressure-volume lines. With the dobutamine infusion, the value for the
slope of the end-systolic pressure-dimension relation increased by 25%
(range 16-46%, p less than 0.001), while the slope of the end-systolic
pressure-volume relation increased by 55% (range 37- 85%, p less than
0.001). In all cases, the curves were linear and became steeper with the
positive inotropic intervention. In contrast, the value of the slope of the
peak systolic pressure-end-systolic dimension relation showed a variable
response to the dobutamine infusion (mean change 13%, range -77% to 73%;
NS). Although the position of the peak systolic pressure-end-systolic
dimension curve is consistently shifted with an alteration in inotropic
state, the values of the slope of these curves are not reliable indicators
of change in LV contractility. The values for the slope of the line
relating end- systolic pressure (estimated by dicrotic notch pressure) to
end- systolic dimension or volume, however, are highly sensitive to a
change in inotropic state in human subjects.
ARTICLES
Sensitivity of end-systolic pressure-dimension and pressure-volume relations to the inotropic state in humans
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