Circulation, Vol 76, 1274-1281, Copyright © 1987 by American Heart Association
MR Starling, DG Montgomery, GB Mancini and RA Walsh
This investigation was designed to determine whether the rate of isovolumic
left ventricular pressure decline is affected by load in man. Fourteen
patients were instrumented with micromanometer left ventricular and right
atrial pacing catheters to maintain a constant heart rate during control
conditions and infusion of methoxamine or nitroprusside. The isovolumic
relaxation period was defined as the time from peak (-)dP/dt to 5 mm Hg
above left ventricular end-diastolic pressure of the following beat. The
rate of isovolumic relaxation was calculated as time constants (Tau) from
the linear regression of natural log pressure vs time (Tln) and
instantaneous (-)dP/dt vs pressure (TD), which includes a variable
asymptote (PB). The mean heart rates and average (+)dP/dt values normalized
at 40 mm Hg development pressure (DP40) did not differ significantly,
despite 33% and 43% increases in left ventricular peak and end-diastolic
pressures during the infusion of methoxamine (p less than .001 and p less
than .01, respectively) and 24% and 29% decreases during the infusion of
nitroprusside (p less than .001 and p less than .01, respectively). The
average Tln and TD values were not significantly affected by these
alterations in load. In two patients, an inverse linear relationship was
demonstrated between decreases in Tau and increases in contractile state
produced by an infusion of dobutamine, as shown by correlation of Tln and
TD with (+)dP/dt/DP40 (r = -.88 and -.83, respectively). We conclude that
the time constants of left ventricular isovolumic relaxation are unaffected
by modest alterations in loading conditions in man when heart rate is
maintained constant.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Load independence of the rate of isovolumic relaxation in man
Division of Cardiology, University of Michigan, Ann Arbor.
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